Mild-to-moderate renal pelvis dilatation identified during pregnancy and hospital admissions in childhood: An electronic birth cohort study in Wales, UK.

Background: Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18–20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission. Methods/Findings: This population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 (n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD (n = 138) compared with those without (n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31–12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26–47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10–93.71, p < 0.001) than in children without RPD (n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69–6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17–19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challenging. Our conclusions were consistent after conducting sensitivity analyses to account for some of these limitations. Conclusions: In this large population-based study, children with RPD at the FAS had higher rates of hospital admissions when there was persistent dilatation in later pregnancy or postpartum. Our results can be used to improve counselling of parents and develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of RPD. Shantini Paranjothy and coworkers investigate whether renal pelvis dilatation identified during the midpregnancy ultrasound scan is associated with higher hospital admission rates during childhood. Author summary: Why was this study done?: Pregnant women usually have an ultrasound scan when they are about 20 weeks pregnant. The purpose of this anomaly scan is to look for structural abnormalities, such as abnormal growth or development of organs. It is not known if some of the findings at this scan are indicators of health problems. For example, fluid-filled areas in the baby's kidneys (called 'renal pelvis dilatation') are sometimes seen, but it is not known whether these are associated with adverse outcomes in childhood. What did the researchers do and find?: In this study, children with renal pelvis dilatation, and a group of children who did not have this finding, were followed until they were three years old. Babies who had this dilatation were more likely to be admitted to hospital with problems in the kidneys and urinary tract than children without dilatation, especially if the finding was still present later in pregnancy or after the birth (HR 25.13, 95% CI 13.26–47.64, p < 0.001). In children with dilatation at the anomaly scan, but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (HR 2.16, 95% CI 0.69–6.75, p = 0.185), except when the initial dilatation was in both kidneys (HR 4.77, 95% CI 1.17–19.47, p = 0.029). What do these findings mean?: These results can be used to improve counselling of parents and to develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of renal pelvis dilatation. [ABSTRACT FROM AUTHOR]