The antenatal urinary tract dilation classification system accurately predicts severity of kidney and urinary tract abnormalities
The antenatal urinary tract dilation classification system accurately predicts severity of kidney and urinary tract abnormalities
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DOI：
10.1016/j.jpurol.2017.03.020
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发表时间：
2017-10-01
影响因子：
2
通讯作者：
Xiao, N.
中科院分区：
文献类型：
--
作者：
Kaspar, C. D. W.;Lo, M.;Xiao, N.
背景尿路扩张（UTD）是一种常见的产前诊断疾病，然而，目前尚不清楚哪些特征导致良性和解决或病理异常。共识UTD分类系统（产前UTD分类，UTD-A）是由Nguyen等人于2014年[1]创建的，但尚未得到验证。目的评价UTD-A系统识别肾脏和泌尿道（KUT）异常的能力，评估UTD-A是否可以预测KUT病症的严重程度，并进行筛查超声（US）的成本分析。MethodsA回顾性单中心研究进行了学术医疗中心。入选标准为：在2011年1月1日至2013年12月31日期间，出生后30天内在健康或疾病护理室进行了完全腹部或有限肾脏US的新生儿。数据收集的产前超声特征，UTD-A分类是回顾性应用，产后数据收集到2年后birth.ResultsA共203例。在36例出生后KUT异常诊断中，90%在产前被确定为UTD A1或UTD A2-3。剩余的10%由于脊髓脊膜膨出而发生出生后KUT异常，如VUR或UTD，这些在产前并不明显。当已消退的UTD计为正常诊断时，UTD-A系统的总体灵敏度和特异性分别为0.767（95%CI 0.577，0.901）和0.836（95%CI 0.758，0.897）。如总结图所示，出生后诊断因UTD-A分类而异。在所有梗阻性尿路病中，90.9%发生在UTD A2-3分类中，无UTD-A正常分类。UTD A1组的出生后UTD消退率（78%）显著高于UTD A2-3组（31%）或UTDA正常组（12%，均P < 0.001）。有一个显着的趋势，对更多的UT手术，UTI，和积极的VUR之间的UTD A2-3患者，但统计学意义是有限的少数patients.ConclusionsThis研究发现，UTD-A分类系统揭示了重要的差异UTD异常的严重程度。通过在较大队列中的重复验证，UTD-A分类可用于为父母提供产前诊断KUT疾病的预后。应设计更大规模的前瞻性研究，以验证UTD-A系统是否可以预测与UTD发病率相关的出生后事件，如需要UT相关手术或UTI。
BackgroundUrinary tract dilation (UTD) is a commonly diagnosed prenatal condition; however, it is currently unknown which features lead to benign and resolving or pathologic abnormalities. A consensus UTD classification system (antenatal UTD classification, UTD-A) was created by Nguyen et al. in 2014 [1], but has not yet been validated.ObjectiveTo evaluate the ability of the UTD-A system to identify kidney and urinary tract (KUT) abnormalities, assess whether UTD-A can predict severity of KUT conditions, and perform a cost analysis of screening ultrasound (US).MethodsA retrospective single-center study was conducted at an academic medical center. Inclusion criteria were: neonates in the well or sick nursery who had a complete abdominal or limited renal US performed in the first 30 days of life between January 01, 2011 and December 31, 2013. Data were collected on prenatal US characteristics from which UTD-A classification was retrospectively applied, and postnatal data were collected up to 2 years following birth.ResultsA total of 203 patients were identified. Of the 36 abnormal postnatal KUT diagnoses, 90% were identified prenatally as UTD A1 or UTD A2-3. The remaining 10% developed postnatal KUT abnormalities due to myelomeningocele, such as VUR or UTD, which were not evident prenatally. Overall sensitivity and specificity of the UTD-A system was 0.767 (95% CI 0.577, 0.901) and 0.836 (95% CI 0.758, 0.897), respectively, when resolved UTD was counted as a normal diagnosis. Postnatal diagnoses differed by UTD-A classification as shown in the Summary fig. Of all the obstructive uropathies, 90.9% occurred in the UTD A2-3 class and none occurred in UTD-A Normal. Rate of postnatally resolved UTD was significantly higher in the UTD A1 group (78%) compared with UTD A2-3 (31%) or UTDA Normal (12%, all P < 0.001). There was a notable trend towards more UT surgeries, UTI, and positive VUR among UTD A2-3 patients, but statistical significance was limited by a small number of patients.ConclusionsThis study found that the UTD-A classification system revealed important differences in the severity of UTD abnormalities. With repeated validation in larger cohorts, the UTD-A classification may be used to offer a prognosis for parents regarding prenatally diagnosed KUT conditions. Larger prospective studies should be designed to validate whether the UTD-A system can predict postnatal events related to UTD morbidity such as need for UT-related surgery or UTI.