Willging Abbygale M, Lence Tomas, Pham Hannah T D, Cooper Christopher S
Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
Department of Urology, University of Iowa, Iowa City, IA, 52242, USA.
J Pediatr Urol. 2025 Apr;21(2):476-481. doi: 10.1016/j.jpurol.2024.12.021. Epub 2024 Dec 28.
Prior analysis of children with grade 3 and 4 congenital hydronephrosis demonstrated that renal medullary pyramidal thickness (PT) is predictive of subsequent pyeloplasty (area under the curve [AUC] = 0.78). The objective of this study was to further analyze the utility of sonographic measurements including PT, anteroposterior pelvic diameter (APD), and renal length with an expansion of the number of infants with hydronephrotic kidneys including grades 2, 3, and 4 hydronephrosis.
A retrospective review was performed of 166 consecutive infants with hydronephrosis (188 hydronephrotic kidneys), out of which 144 had unilateral hydronephrosis and 22 had bilateral hydronephrosis. 109 kidneys were observed and 79 underwent pyeloplasty. Indications for surgery included an obstructive drainage pattern with a T1/2 > 20 min on diuretic renal scan in addition to decreased relative renal function less than 40 %, or increasing hydronephrosis on serial ultrasounds, and/or a decline in relative renal function >10 % on serial renal scans. The PT, APD, and renal length were measured on sonographic images. Receiver operating characteristic (ROC) curves were generated for inclusive multivariate models for prediction of pyeloplasty with and without Society for Fetal Urology (SFU) grade.
The AUC of the ROC constructed using only PT to predict pyeloplasty was 0.82, which indicates strong predictive ability. A PT cutoff of 3 mm would identify 72 % of kidneys requiring pyeloplasty and accurately exclude 81 % of those not needing the procedure. Logistic regression modeling identified PT ≤ 3 mm, APD, SFU grade, and female gender as significant factors associated with increased risk of pyeloplasty. The ROC curves of the predictive performance of multivariate predictive models with and without SFU grade demonstrated an AUC of 0.901 and 0.868, respectively.
These results further support PT as a reliable and useful measurement to characterize the hydronephrotic kidney parenchyma and that a PT ≤ 3 mm is a useful criterion for "thinned parenchyma," which could be used to differentiate kidneys in the SFU, UTD, and other hydronephrosis grading systems. Predictive models using only sonographic measurements, including PT, APD, and renal length, were almost as accurate as models incorporating SFU grade with the former offering the advantage of being more objective and reliable.
先前对3级和4级先天性肾积水患儿的分析表明，肾髓质锥体厚度（PT）可预测后续的肾盂成形术（曲线下面积[AUC]=0.78）。本研究的目的是进一步分析超声测量指标（包括PT、肾盂前后径[APD]和肾长度）的效用，纳入的肾积水婴儿数量有所增加，涵盖2级、3级和4级肾积水。
对166例连续性肾积水婴儿（188个肾积水肾脏）进行回顾性研究，其中144例为单侧肾积水，22例为双侧肾积水。观察了109个肾脏，79个接受了肾盂成形术。手术指征包括利尿肾图T1/2>20分钟的梗阻性引流模式，以及相对肾功能下降至低于40%，或超声检查显示肾积水加重，和/或肾系列扫描显示相对肾功能下降>10%。在超声图像上测量PT、APD和肾长度。针对有无胎儿泌尿外科学会（SFU）分级的肾盂成形术预测综合多变量模型生成受试者操作特征（ROC）曲线。
仅使用PT预测肾盂成形术构建的ROC曲线的AUC为0.82，表明具有较强的预测能力。PT阈值为3mm可识别72%需要进行肾盂成形术的肾脏，并准确排除81%不需要该手术的肾脏。逻辑回归模型确定PT≤3mm、APD、SFU分级和女性性别是与肾盂成形术风险增加相关的显著因素。有无SFU分级的多变量预测模型预测性能的ROC曲线的AUC分别为0.901和0.868。
这些结果进一步支持PT作为一种可靠且有用的测量指标来表征肾积水肾实质，PT≤3mm是“肾实质变薄”的有用标准，可用于在SFU、UTD和其他肾积水分级系统中区分肾脏。仅使用超声测量指标（包括PT、APD和肾长度）的预测模型几乎与纳入SFU分级的模型一样准确，前者具有更客观可靠的优势。
