A new grading system for the management of antenatal hydronephrosis

Joana Dos Santos, Rulan S. Parekh, Tino D. Piscione, Tarek Hassouna, Victor Figueroa, Paula Gonima, Isis Vargas, Walid Farhat, Norman D. Rosenblum

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system. Design, setting, participants, & measurements A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+). Results The combination of APD≥6–9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD≥6–9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD≥9–15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD≥9–15 mm alone. The LR+ for surgery for diffuse caliectasis and APD≥6–9 mm was higher than for APD≥6–9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD≥9–15 mm and diffuse caliectasis than APD≥9–15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD≥6–9 mm or ≥9–15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05). Conclusions These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.

Original languageEnglish (US)
Pages (from-to)1783-1790
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number10
DOIs
StatePublished - Oct 7 2015
Externally publishedYes

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

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