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Kidney Week

Abstract: PO1956

Prediction Model of CKD at the Age of One Year Following Prenatal Severe Urinary Tract Dilatation

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Borovitz, Yael, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
  • Geron, Yossi, Rabin Medical Center, Petah Tikva, Israel
  • Davidovits, Miriam, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
  • Gilboa, Yinon, Rabin Medical Center, Petah Tikva, Israel
  • Perlman, Sharon, Rabin Medical Center, Petah Tikva, Israel
Background

Early childhood chronic kidney disease (CKD) has a wide spectrum of health and developmental implications. Renal replacement therapy may be needed during childhood. Prenatal counselling regarding future renal outcome in cases presenting prenataly with severe urinary tract dilatation (UTD) is challenging. We aimed to create a prenatal ultrasound model for the prediction of early childhood CKD following fetal severe UTD.

Methods

A retrospective cohort study was conducted in a national referral centre .Fetuses diagnosed with severe UTD and maintained follow up comprised the study group. The main outcome was CKD at the age of one year. Logistic regression analysis was used to identify prognostic prenatal ultrasound variables for the renal outcome. Analysis of Maximum Likelihood Estimates was performed to create a multivariable predictive model.

Results

87 fetuses comprised the study group. 15 cases (17.2%) developed CKD by the age of one year. In all, renal dysfunction and renal dysplasia were diagnosed at birth. Post-natal diagnoses were lower urinary tract obstruction in 5 cases ,vesical-ureteral reflux in 10 cases. Bilateral hydronephrosis, abnormal bladder, hydroureter, calyceal dilatation, and abnormal parenchyma, were all significantly related to CKD at the age of one year. A combination of prenatal ultrasound variables yielded a model with a discriminatory ability of c=0.976.

Conclusion

A prediction model incorporating prenatal ultrasound features can discriminate between a normal and an impaired renal outcome at the age of one year. These sonographic features are related to the extent of renal dysplasia and to the remaining functioning nephron mass. Data presented may be used to develop more effective risk assessments and customized parent counseling.