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Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury

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Abstract

Background

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.

Methods

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).

Results

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).

Conclusions

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.

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Funding

This study was partially supported by CNPq (Brazilian National Research Council, Grant 302258/2019–1, 430246/2018–8, 302154/2016–7) and FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Grant PPM-00228–15, PPM-00435–18). R.H.M. is supported by NIH grants 2U01DK066143-16 and 1R01DK125811. E.A.O. is supported by grant CAPES 2746–15-8. ACSS is supported by CNPq Grant 302153/2019–5. Dr. E.A. Oliveira and Dr. A.C. Simões e Silva received a research grant from the Brazilian Research Council (CNPq).

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Authors and Affiliations

  1. 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

    Fernanda F. Melo, Mariana A. Vasconcelos, Ana Cristina Simões e Silva, Cristiane S. Dias, Ludmila R. Silva, Maria Christina L. Oliveira & Eduardo A. Oliveira

  2. Division of Pediatric Nephrology, Rady Children’s Hospital San Diego, University of California, San Diego, La Jolla, CA, USA

    Robert H. Mak

  3. Department of Statistics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil

    Enrico A. Colosimo

  4. Visiting Scholar, Division of Pediatric Nephrology, Rady Children’s Hospital San Diego, University of California, San Diego, La Jolla, CA, USA

    Eduardo A. Oliveira

Authors
  1. Fernanda F. Melo
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  2. Mariana A. Vasconcelos
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  4. Ana Cristina Simões e Silva
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  6. Enrico A. Colosimo
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  7. Ludmila R. Silva
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  8. Maria Christina L. Oliveira
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  9. Eduardo A. Oliveira
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Correspondence to Eduardo A. Oliveira.

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The study was approved by the Ethics Committee of UFMG and the parents or persons responsible for the children gave written informed consent to participate.

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The authors declare no competing interests.

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Melo, F.F., Vasconcelos, M.A., Mak, R.H. et al. Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury. Pediatr Nephrol 37, 613–623 (2022). https://doi.org/10.1007/s00467-021-05254-x

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  • DOI: https://doi.org/10.1007/s00467-021-05254-x

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