Melo Fernanda F, Vasconcelos Mariana A, Mak Robert H, Silva Ana Cristina Simões E, Dias Cristiane S, Colosimo Enrico A, Silva Ludmila R, Oliveira Maria Christina L, Oliveira Eduardo A
Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil.
Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
Pediatr Nephrol. 2022 Mar;37(3):613-623. doi: 10.1007/s00467-021-05254-x. Epub 2021 Aug 28.
The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy.
Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC).
Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7-12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883-0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854-0.915) (P = 0.027).
Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
产后超声检查中对泌尿道扩张（UTD）进行分级是为产前肾积水（ANH）婴儿制定合理治疗方案的基本步骤。本研究的目的是比较UTD分级系统对相关临床结局的预测准确性。此外，我们建议通过增加定量测量来完善UTD分类，并评估其对准确性的影响。
1989年至2019年间，对447例诊断为孤立性AHN的婴儿进行了前瞻性随访。关注的事件为手术干预和肾损伤。通过受试者操作特征曲线（AUC）下面积评估分级系统的性能比较以及改良UTD分类（包括肾实质大小）对准确性的影响。
447例婴儿中，131例（29%）接受了手术干预，26例（5.8%）发生了肾损伤。中位随访时间为9年（四分位间距，7 - 12年）。所有分级系统在检测手术干预需求方面的性能都非常出色（AUC＞0.90）。然而，对于预测肾损伤，与UTD分类（AUC = 0.887，95%CI，0.854 - 0.915）相比，改良UTD分类在准确性上有显著提高（AUC = 0.913，95%CI，0.883 - 0.937）（P = 0.027）。
我们的研究证实，肾积水分级系统在区分AHN婴儿中需要手术干预的患者方面具有出色的准确性。我们的研究结果表明，在UTD分类中纳入肾实质厚度可能会提高预测可能发生肾损伤婴儿的准确性。更高分辨率的图形摘要作为补充信息提供。
