title: [Predictive factors of the outcomes of prenatal hydronephrosis.]
abstract: OBJECTIVE
  To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis.
  
  
  METHODS
  We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves.
  
  
  RESULTS
  We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21-11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome.
  
  
  CONCLUSIONS
  The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients.
authors.affiliation: Servicio Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife. España.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bragagnini
authors.affiliation: Hospital Universitario Son Espaces. Palma de Mallorca. España.
authors.forename: Blanca
authors.initials: B
authors.lastname: Estors
authors.affiliation: Servicio de Cirugía Pediátrica Hospital Infantil "Miguel Servet". Zaragoza. España.
authors.forename: Reyes
authors.initials: R
authors.lastname: Delgado
authors.affiliation: Servicio de Cirugía Pediátrica Hospital Infantil "Miguel Servet". Zaragoza. España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Rihuete
authors.affiliation: Servicio de Cirugía Pediátrica Hospital Infantil "Miguel Servet". Zaragoza. España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Gracia
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal