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Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: a prospective study
Author(s) -
Bouzada M. C. F.,
Oliveira E. A.,
Pereira A. K.,
Leite H. V.,
Rodrigues A. M.,
Fagundes L. A.,
Gonçalves R. P.,
Parreiras R. L.
Publication year - 2004
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.1764
Subject(s) - medicine , obstructive uropathy , voiding cystourethrogram , renal pelvis , receiver operating characteristic , urinary system , pelvis , ultrasound , radiology , prospective cohort study , urology , surgery , vesicoureteral reflux , disease , reflux
Objective The purpose of this study was to assess the accuracy of prenatal ultrasound measurement of anteroposterior renal pelvis diameter (APD) to discriminate between significant uropathy and idiopathic renal pelvis dilatation. Methods One‐hundred‐and‐three neonates who were found to have fetal renal pelvis dilatation, defined as presence of an APD ≥ 5 mm, underwent systematic investigation for uropathies and were prospectively followed. An ultrasound scan was performed after the first week of postnatal life and all infants underwent a voiding cystourethrogram. Neonates with an APD larger than 10 mm underwent renal scintigraphy. Ultrasound scans, clinical examination and laboratory reviews were scheduled at 6‐month intervals. Receiver–operating characteristics (ROC) curves were constructed to determine the best cut‐offs for APD to identify renal units with significant uropathy as well as those requiring surgical intervention. Significant uropathy was defined as the presence of well‐established urinary tract abnormalities or when there was abnormal renal scintigraphy. Results The estimated area under the curve for APD was 0.900 (95% CI, 0.841–0.942) indicating excellent power to discriminate between idiopathic pelvis dilatation and significant uropathy. The sensitivity and specificity for the 7.5 mm cut‐off point were 97.9% and 40.6%, respectively. To identify infants who required surgical intervention, the calculated area under the curve was 0.953 (95% CI, 0.908–0.980). Conclusion Our results suggest that measurement of APD is an excellent test to identify fetuses with significant uropathy, as well as those requiring postnatal intervention. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.