Division of Pediatric Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Division of Pediatric Nephrology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Urol. 2016 Sep;196(3):862-8. doi: 10.1016/j.juro.2016.03.137. Epub 2016 Mar 25.
There is paucity of validated objective early imaging markers to help predict future renal deterioration in infants with posterior urethral valves. We evaluated the prognostic value of total renal parenchymal area, renal echogenicity and corticomedullary differentiation regarding future development of chronic kidney disease.
We analyzed initial postnatal ultrasonographic images from serial posterior urethral valve cases seen at a single tertiary referral center using National Institutes of Health sponsored image processing software. Echogenicity and corticomedullary differentiation were objectively measured as ratios relative to the adjacent liver or spleen and between cortex and medulla. The primary study outcome, renal function at last followup, was dichotomized based on glomerular filtration rate and/or need for renal replacement therapy (dialysis or renal transplantation, stage 5 chronic kidney disease).
A total of 75 patients were evaluated, of whom 16 had progression to stage 5 chronic kidney disease after a mean ± SD followup of 64.2 ± 38.9 months. Mean renal parenchymal area was 21.41 cm(2) in patients without and 16 cm(2) in patients with stage 5 chronic kidney disease (p <0.001), and mean corticomedullary differentiation was 1.77 and 1.21, respectively (p <0.001). Bilateral echogenic kidneys were significantly associated with development of stage 5 chronic kidney disease (p = 0.004). The performance of corticomedullary differentiation in predicting stage 5 chronic kidney disease was statistically significant (AUROC 0.881, 95% CI 0.776-0.987, p <0.001).
Estimates of renal parenchyma quantity (total renal parenchymal area) and quality (corticomedullary differentiation and renal echogenicity) measured on initial postnatal ultrasound carry prognostic value in determining future risk of stage 5 chronic kidney disease in patients with posterior urethral valves. These data are promising for developing tools to risk stratify patients, counsel parents and customize monitoring protocols.
目前缺乏经验证的客观早期影像学标志物来帮助预测患有后尿道瓣膜婴儿的未来肾功能恶化。我们评估了总肾实质面积、肾回声和皮质髓质分化对未来慢性肾脏病发展的预后价值。
我们使用美国国立卫生研究院赞助的图像处理软件分析了在单一三级转诊中心就诊的连续后尿道瓣膜病例的初始产后超声图像。回声和皮质髓质分化作为与相邻肝脏或脾脏的比值以及皮质和髓质之间的比值进行客观测量。主要研究结果是最后一次随访时的肾功能，根据肾小球滤过率和/或是否需要肾脏替代治疗（透析或肾移植，慢性肾脏病 5 期）进行二分类。
共评估了 75 例患者，其中 16 例在平均随访 64.2 ± 38.9 个月后进展为慢性肾脏病 5 期。无慢性肾脏病 5 期患者的平均肾实质面积为 21.41 cm²，而有慢性肾脏病 5 期患者的平均肾实质面积为 16 cm²（p <0.001），平均皮质髓质分化分别为 1.77 和 1.21（p <0.001）。双侧回声增强的肾脏与发展为慢性肾脏病 5 期显著相关（p = 0.004）。皮质髓质分化预测慢性肾脏病 5 期的表现具有统计学意义（AUROC 0.881，95%CI 0.776-0.987，p <0.001）。
在患有后尿道瓣膜的婴儿中，在初始产后超声上测量的肾实质量（总肾实质面积）和质量（皮质髓质分化和肾回声）估计值具有预后价值，可以确定未来发展为慢性肾脏病 5 期的风险。这些数据为开发风险分层患者、为家长提供咨询和定制监测方案的工具提供了希望。
