The different elements of the Urinary Tract Dilation (UTD) Classification System and their capacity to predict findings on mercaptoacetyltriglycine (MAG3) diuretic renography.
Diuretic renography; Hydronephrosis; Mercaptoacetyltriglycine
INTRODUCTION: The UTD Classification System risk stratifies postnatal UTD into three groups: low risk (UTD P1), intermediate risk (UTD P2), and high risk (UTD P3). In the original consensus document, a functional scan is not recommended for UTD P1 and is left to the discretion of the clinician for UTD P2 and P3. OBJECTIVE: This study aims to understand which patients with postnatal urinary tract dilation would benefit from a functional study. We investigated how different elements of the UTD classification system predict differential renal function (DRF) and diuretic half-life (T½) on MAG3 scan in infants undergoing evaluation for prenatally detected UTD. STUDY DESIGN: This is a multicenter retrospective chart review of infants 6 months of age or younger evaluated for prenatal UTD, correlating their first MAG3 scan and first postnatal renal ultrasound (RUS). Multivariable logistic regression was used to find UTD elements predictive of DRF < 40% and/or T½ > 20 min. RESULTS: A total of 517 patients met study criteria. Median age at time of RUS and MAG3 renal scan was 48 days (IGR 31-81) and 63 days (IQR 45-98), respectively. DRF < 40% was found in 6% of kidneys with UTD P2 and 35% of kidneys with UTD P3. T½ > 20 min was found in 31% of kidneys with UTD P2 and 79% of kidneys with UTD P3. An abnormal ureter (OR 2.7, 95% CI 1.2-6.0) and parenchymal thinning (OR 16, 95% CI 5.8-41.4) were significant at predicting DRF < 40%. Parenchymal thinning (OR 3.0, 95% CI 1.5-6.1) also predicted T½ > 20 min, as did each cm increase in the anterior-posterior renal pelvic diameter (APRPD) (OR 4.8, 95% CI 3.0-7.7). DISCUSSION: The UTD system discriminates well and correlates with the likelihood of finding adverse features on diuretic renography. Patients in the UTD P3 high-risk category had a significantly higher incidence of decreased differential renal function and delayed drainage than those in UTD P1 and P2. Of the individual components of the UTD Classification system, the presence of parenchymal thinning was the most important factor in predicting both decreased differential renal function and delayed drainage. CONCLUSION: Given the high incidence of poor function and delayed drainage seen in the UTD P3 group, we believe a functional study should be recommended in the evaluation of these patients. Our findings support leaving the performance of a functional study at the discretion of the physician for UTD P2.
Agard H; Massanyi E; Albertson M; Anderson M; Alam M; Lyden E; Del Rio CV
Journal of Pediatric Urology
2020
2020-08-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jpurol.2020.07.045" target="_blank" rel="noreferrer noopener">10.1016/j.jpurol.2020.07.045</a>
Impact of trauma center designation in pediatric renal trauma: national trauma data bank analysis.
Outcomes; National Trauma Data Bank; Renal trauma; Trauma level
INTRODUCTION: The pediatric kidney is the most common urinary tract organ injured in blunt abdominal trauma. Trauma care in the United States has been established into a hierarchical system verified by the American College of Surgeons (ACS). Literature evaluating management of pediatric renal trauma across trauma tier designations is scarce. OBJECTIVE: To examine the differences in the management and outcomes of renal trauma in the pediatric population based on trauma level designation across the United States. STUDY DESIGN: We performed a review of the ACS - National Trauma Data Bank database. Pediatric patients (age 0-18 years) who were treated for renal injury between years 2011-2016 were identified. Our primary outcome was the difference in any complication rate amongst Level I versus Non-Level I trauma centers. Management strategies were evaluated as secondary outcomes. Propensity score matching (PSM) was utilized to adjust for baseline differences between cohorts. Multivariable regression analysis was performed to determine the independent effects of individual factors on complications, operative intervention, minimally invasive procedure, and blood transfusions. RESULTS: Overall, 12,097 pediatric patients were diagnosed with renal trauma between 2011 and 2016 using target ICD-9 and AAST codes. After PSM, there was a total of 1623 subjects withing each group. No difference was identified between groups for occurrence on any complication [105 (6.5%) vs 114 (7.0%), p = 0.576. There were no differences in the rate of minimally invasive interventions [67 (4.1%) vs 48 (3.0%), p = 0.087], operative intervention [58 (3.6%) vs 68 (4.2%), p = 0.413], or nephrectomy [42 (2.6%) vs 47 (2.9%), p = 0.667] between Level I and Non-Level I trauma designations, respectively. Length of stay was longer in the Level I cohort compared to Non-Level I (days (SD)) [6.9 (8.8) vs 6.2 (7.9), p = 0.024. When specifically looking at risk factors associated with operative intervention, higher renal injury grade and injury severity score were highly correlated, whereas, trauma level designation was not found to be predictive for more aggressive management. DISCUSSION & CONCLUSION: Our results corroborate with previous literature that renal injury grade and injury severity score are strong predictors of morbidity, invasive management, and complications. Pediatric renal trauma was managed similarly across trauma center designations, with the rate of complication and intervention more prevalent in patients with high grade renal injuries and concomitant injuries. Further studies are necessary to identify patients who will benefit most from transfer to a level I center.
Mahran A; Fernstrum A; Swindle M; Mishra K; Bukavina L; Raina R; Narayanamurthy V; Ross J; Woo L
Journal of Pediatric Urology
2020
2020-07-24
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jpurol.2020.07.019" target="_blank" rel="noreferrer noopener">10.1016/j.jpurol.2020.07.019</a>