Ji Baowei, Gong Yinv, Zhang Ying, Li Yun, Zhai Yihui, Sun Yinghua, Wang Xiang, Jia Lishan, Xu Hong, Shen Qian
Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.
Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China.
Front Pediatr. 2023 Apr 24;11:1162952. doi: 10.3389/fped.2023.1162952. eCollection 2023.
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are the primary cause of end-stage renal disease in children, early diagnosis and treatment can significantly improve the kidney function. Among CAKUT, renal pelvis dilatation (RPD) due to various causes has the highest detection rate, which can be detected early by postnatal ultrasound screening. Since 2010, the Children's Hospital of Fudan University (CHFU), together with the Minhang District Maternal and Child Health Hospital (MCH) and Community Health Centres (CHCs) of Minhang District has created a three-level referral system for urological ultrasound screening. This study aims to describe the operation of a three-level referral system for ultrasound screening of CAKUT and to select risk factors of RPD in high-risk children.
The operation of the three-level referral system was assessed by analyzing the screening volume, screening rate, referral rate, and follow-up rate; risk factors of RPD in high-risk children were selected by chi-square test and multivariate logistic regression.
A total of 16,468 high-risk children were screened in ten years, and the screening volume was maintained at about 1,500 cases per year; the screening rate showed a linear increase, from 36.8% in 2010 to 98.2% in 2019; the referral rate from the CHCs to the MCH was 89.9% significantly higher after 2015 than that of 84.7% from 2010 to 2015; the follow-up rate after 2015 was 71.0% significantly higher than that of 46.3% from 2010 to 2015. Multivariate logistic regression analysis showed that the risk of RPD was 1.966 times higher in males than in females, and the risk of moderate to severe RPD was 2.570 times higher in males than in females; the risk of RPD in preterm children was 1.228 times higher than that of full-term children; and the risk of RPD was 1.218 times higher in twins than in singles.
The screening volume of the three-level referral system has remained stable over a decade, with significantly higher screening, referral, and follow-up rates. Males, preterm, and twins are risk factors of RPD in high-risk children; males are also risk factors for moderate to severe RPD in high-risk children.
先天性肾脏和尿路畸形（CAKUT）是儿童终末期肾病的主要原因，早期诊断和治疗可显著改善肾功能。在CAKUT中，各种原因导致的肾盂扩张（RPD）检出率最高，可通过产后超声筛查早期发现。自2010年以来，复旦大学附属儿科医院（CHFU）与闵行区妇幼保健院（MCH）及闵行区社区卫生服务中心（CHCs）建立了泌尿系统超声筛查三级转诊系统。本研究旨在描述CAKUT超声筛查三级转诊系统的运行情况，并筛选高危儿童RPD的危险因素。
通过分析筛查量、筛查率、转诊率和随访率评估三级转诊系统的运行情况；采用卡方检验和多因素logistic回归筛选高危儿童RPD的危险因素。
十年间共筛查16468例高危儿童，筛查量维持在每年约1500例；筛查率呈线性上升，从2010年的36.8%升至2019年的98.2%；社区卫生服务中心至妇幼保健院的转诊率在2015年后显著提高，为89.9%，高于2010年至2015年的84.7%；2015年后的随访率为71.0%，显著高于2010年至2015年的46.3%。多因素logistic回归分析显示，男性RPD风险是女性的1.966倍，男性中重度RPD风险是女性的2.570倍；早产儿RPD风险是足月儿的1.228倍；双胞胎RPD风险是单胎的1.218倍。
三级转诊系统的筛查量在十年间保持稳定，筛查、转诊和随访率显著提高。男性、早产儿和双胞胎是高危儿童RPD的危险因素；男性也是高危儿童中重度RPD的危险因素。
