PURPOSE Renal ultrasounds are performed in patients with myelomeningocele to screen for markers of kidney health, including hydronephrosis. We evaluated the diagnostic accuracy of hydronephrosis to screen for low kidney function defined by estimated glomerular filtration rate (eGFR). MATERIALS AND METHODS We performed a retrospective cross-sectional study using data from 2 cohorts of children and youth with myelomeningocele. The first cohort is the Urological Management to Preserve Initial Renal Function Protocol for Young Children With Spina Bifida (UMPIRE; 2016-2022) and the second from the National Spina Bifida Patient Registry (NSBPR; 2009-2021). We identified patients aged 1 to 18 years with available eGFR data within 6 months of an ultrasound. We excluded NSBPR patients younger than 6 years to address potential duplication across cohorts. The primary outcome was eGFR < 90 mL/min/1.73 m2, calculated using the bedside Schwartz formula. Hydronephrosis was dichotomized into any/none. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of any hydronephrosis using eGFR as the reference standard. RESULTS In UMPIRE, 221 patients were included with median age 2.4 years (IQR, 1.9-3.8) and 24% having eGFR < 90. Any hydronephrosis vs none conferred a sensitivity/specificity/PPV/NPV of 25%/75%/24%/77%, respectively. In NSBPR, 2269 patients were included with median age 13 years (IQR, 9.6-16.3) and 17% having eGFR < 90. Any hydronephrosis vs none conferred a sensitivity/specificity/PPV/NPV of 24%/87%/26%/85%, respectively. CONCLUSIONS In 2 cohorts of children and youth with myelomeningocele, hydronephrosis conferred a sensitivity of ∼25% for a creatinine-based eGFR < 90 mL/min/1.73 m2. This low sensitivity suggests that hydronephrosis alone is a poor screening marker of kidney health.

中文翻译：

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基于超声的肾积水治疗脊髓脊膜膨出儿童和青少年慢性肾病的诊断测试特征：UMPIRE 和 NSBPR 队列研究的结果。


目的 对脊髓脊膜膨出患者进行肾脏超声检查，以筛查肾脏健康的标志物，包括肾积水。我们评估了肾积水的诊断准确性，以筛查由估计肾小球滤过率 （eGFR） 定义的低肾功能。材料和方法 我们使用 2 组脊髓脊膜膨出儿童和青少年的数据进行了一项回顾性横断面研究。第一个队列是脊柱裂幼儿保留初始肾功能的泌尿外科管理方案（UMPIRE;2016-2022），第二个队列来自国家脊柱裂患者登记处（NSBPR;2009-2021）。我们确定了 1 至 18 岁的患者，并在超声检查后 6 个月内获得可用的 eGFR 数据。我们排除了 6 岁以下的 NSBPR 患者，以解决队列间可能存在的重复问题。主要结局是 eGFR < 90 mL/min/1.73 m2，使用床旁 Schwartz 公式计算。肾积水分为 any/none 两分为两部分。我们使用 eGFR 作为参考标准计算了任何肾积水的敏感性、特异性、阳性预测值 （PPV） 和阴性预测值 （NPV）。结果 在 UMPIRE 中，纳入 221 例患者，中位年龄 2.4 岁 （IQR，1.9-3.8），24% 的患者 eGFR < 90。任何肾积水与无肾盂积水的敏感性/特异性/PPV/NPV 分别为 25%/75%/24%/77%。在 NSBPR 中，纳入 2269 例患者，中位年龄为 13 岁 （IQR，9.6-16.3），17% 的患者 eGFR < 90。任何肾盂积水与无肾盂的敏感性/特异性/PPV/NPV 分别为 24%/87%/26%/85%。结论在 2 例脊髓脊膜膨出儿童和青少年队列中，肾积水对基于肌酐的 eGFR < 90 mL/min/1.73 m2 的敏感性为 ∼25%。 这种低敏感性表明，单独的肾积水是肾脏健康的不良筛查标志物。