Liu Huili,Liu Xin,Yin Xiaoming,et al.Correlation between anteroposterior renal pelvic diameter and outcomes of fetal hydronephrosis.[J].Journal of Clinical Pediatric Surgery,,17():412-418.
Correlation between anteroposterior renal pelvic diameter and outcomes of fetal hydronephrosis.
Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R]
volume:
第17卷
Number:
2018 06
Page:
412-418
Column:
专题讨论
Date of publication:
2018-06-28
- Keywords:
- Fetus; Hydronephrosis; Kidney Pelvis/AB; Ureteral Obstruction; Prognosis
- Document code:
- A
- Abstract:
- ObjectiveTo evaluate the diagnostic accuracy of renal pelvic dilatation and explore whether postoperative differential renal function (DRF) may be improved in infants with ureteropelvic junction obstruction (UPJO). MethodsBetween 2015 and 2017, 245 newborns diagnosed with isolated prenatal hydronephrosis were retrospectively reviewed. Diagnostic sensitivity, specificity and area under the curve (AUC) of anterioposterior diameter (APD) in late stage of pregnancy and 1 week after birth were evaluated. The preoperative and postoperative changes of DRF were analyzed. Primary outcome measures were >5% improvement in baseline DRF. ResultsA total of 245 patients were recruited. Multivariate Logistic regression analysis indicated that APD in late stage of pregnancy (OR=0.17, 95%CI:0.09-0.40) and 1 week after birth (OR=0.21, 95%CI:0.10-0.42) were protective factors for postpartum selfhealing in children with hydronephrosis and risk factors for pyeloplasty in postpartum children with hydronephrosis (OR=1.53,95%CI:1.32-1.77; OR=1.60, 95%CI:1.601.36-1.88). The optimal critical points for postpartum selfhealing of APD in late pregnancy and 1 week after birth were 8.3 mm and 12 mm. The sensitivity were 83% and 93%, specificity 71% and 76% and AUC 0.79 and 0.86 respectively. The AUC of combination with two indicators to predict whether postpartum selfhealing was 0.87 and sensitivity, specificity and Jordan index were 96%, 38% and 0.69 respectively. The optimal critical points for postpartum pyeloplasty in children with hydronephrosis were 19 mm and 19 mm with sensitivity of 68% and 78%, specificity of 71% and 69%, and AUC of 0.71 and 0.78 respectively. The AUC of combination with two indicators to predict whether pyeloplasty was 0.84 and sensitivity, specificity and Jordan index were 89%, 34% and 0.59 respectively. Postoperative renal functions improved in childrens with preoperative DRF<40% and DRF≥40%. The effects were more pronounced in the former group (t=3.14,P<0.001). However, postoperative renal functions of the former group failed to reach the levels of those of the latter group. ConclusionThe combination of APD in the late stage of pregnancy and 1 week after birth may increase the accuracy of prognosis. And DRF improves after pyeloplasty in children with hydronephrosis.
Last Update:
2018-06-26