The Study Of The Value Of Key Ultrasonographic Parameters In Predicting Differential Renal Function In Children With Unilateral UPJO

Part One.The Role of A New Scoring System Based On Key Parameters of Urinary Tract Ultrasound In Predicting DRF < 40% in Hydronephrosis.Objectives: In order to predict the incidence of DRF < 40% in children with hydronephrosis,we established a novel weighted quantitative scoring system based on urinary tract ultrasound.Methods: We retrospectively reviewed the dynamic renogram and urinary tract ultrasound data of 651 children with hydronephrosis presented to our department.Independent risk factors related to DRF < 40% were screened out,and then a novel scoring system was established based on the OR from multivariate logistic regression.ROCs were drawn to verify the efficiency of the scoring system.Results: APD,upper calyx dilation and renal length ratio were independent risk factors for DRF < 40%.After four independent influencing factors were converted into categorical variables,the ORs of each level of each factor from logistic regression were used to assign a new value,and then each patient was scored.The AUC of the novel scoring system was 0.842,with a sensitivity of 80.2% and a specificity of 73.3%.Conclusion: The length ratio had the strongest correlation among the four independent influential factors.The scoring system established by combining the above four independent influencing factors could better predict the risk of DRF < 40% than any single factor.It may be used to screen out high-risk children in the follow-up of congenital hydronephrosis.Part two.The Analysis of Ultrasonographic And Clinical Features And Their Association With DRF In Children With Intermittent Hydronephrosis.Objectives: Intermittent hydronephrosis is characterized by a significant increase in renal pelvic dilation during the onset of symptoms than asymptomatic periods.Most patients have well-preserved DRF.We attempted to summarize the ultrasonographic and clinical manifestations of intermittent hydronephrosis and find out the risk factors for DRF loss.Methods:We retrospectively reviewed patients presenting to our department with Dietl's Crisis between January 2014 and December 2017.Clinical characteristics were collected,including age of first onset,time of onset,the duration of the longest single episodes and whether the patient had hydronephrosis prenatally.Ultrasonographic parameters included anteroposterior diameter(APD)during the symptomatic and asymptomatic period.Dynamic renograms(DR)were reviewed to obtain preoperative DRF.Results: A total of 150 patients met the inclusion criteria.Of the 128 patients whose mother had regular obstetric ultrasounds during pregnancy,50(39.06%)had prenatal pelvic dilation.The mean age of the first attack was earlier in the prenatal hydronephrosis group than in postnatal group(4.58 y vs 5.87 y,P=0.002).The mean preoperative DRF was 41.03% in all patients.Patients whose DRFs were below 40% had longer durations of single attacks and larger APD during the symptomatic and asymptomatic periods than those with DRF over 40%.The times of attack,waiting time before the surgery and age of the first onset had no association with preoperative DRF.Conclusion: Children with prenatal hydronephrosis may develop Dietl's Crisis at an early age.A long duration of a single attack and an APD over 40 mm are associated with DRF loss before surgery.