title: Predicting Risk of Chronic Kidney Disease in Infants and Young Children at Diagnosis of Posterior Urethral Valves: Initial Ultrasound Kidney Characteristics and Validation of Parenchymal Area as Forecasters of Renal Reserve.
abstract: OBJECTIVE
  There is paucity of validated objective early imaging markers to help predict future renal deterioration in infants with posterior urethral valves. We evaluated the prognostic value of total renal parenchymal area, renal echogenicity and corticomedullary differentiation regarding future development of chronic kidney disease.
  
  
  METHODS
  We analyzed initial postnatal ultrasonographic images from serial posterior urethral valve cases seen at a single tertiary referral center using National Institutes of Health sponsored image processing software. Echogenicity and corticomedullary differentiation were objectively measured as ratios relative to the adjacent liver or spleen and between cortex and medulla. The primary study outcome, renal function at last followup, was dichotomized based on glomerular filtration rate and/or need for renal replacement therapy (dialysis or renal transplantation, stage 5 chronic kidney disease).
  
  
  RESULTS
  A total of 75 patients were evaluated, of whom 16 had progression to stage 5 chronic kidney disease after a mean ± SD followup of 64.2 ± 38.9 months. Mean renal parenchymal area was 21.41 cm(2) in patients without and 16 cm(2) in patients with stage 5 chronic kidney disease (p <0.001), and mean corticomedullary differentiation was 1.77 and 1.21, respectively (p <0.001). Bilateral echogenic kidneys were significantly associated with development of stage 5 chronic kidney disease (p = 0.004). The performance of corticomedullary differentiation in predicting stage 5 chronic kidney disease was statistically significant (AUROC 0.881, 95% CI 0.776-0.987, p <0.001).
  
  
  CONCLUSIONS
  Estimates of renal parenchyma quantity (total renal parenchymal area) and quality (corticomedullary differentiation and renal echogenicity) measured on initial postnatal ultrasound carry prognostic value in determining future risk of stage 5 chronic kidney disease in patients with posterior urethral valves. These data are promising for developing tools to risk stratify patients, counsel parents and customize monitoring protocols.
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rakan
authors.initials: R
authors.lastname: Odeh
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Damien
authors.initials: D
authors.lastname: Noone
authors.affiliation: Department of Surgery, Section of Pediatric Urology at Children's Mercy Hospital, University of Kansas Medical Center and University of Missouri-Kansas City School of Medicine, Kansas City, Kansas.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Bowlin
authors.affiliation: Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Luis H P
authors.initials: LH
authors.lastname: Braga
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Electronic address: armando.lorenzo@sickkids.ca.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
mesh_terms: D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods*; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014522:Urethral Diseases / Q000150:complications* / Q000151:congenital / Q000175:diagnosis
keywords: kidney cortex; kidney medulla; renal insufficiency, chronic; renal replacement therapy; urethra