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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography

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Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While

Stefano Guarino1, Anna Di Sessa1, Simona Riccio1

  • 1Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Naples, Italy.

Journal of Clinical Medicine
|February 25, 2022
PubMed

Insights

Renal length (RL) over 2 standard deviation scores (SDS) on early renal ultrasound (RUS) in infants with congenital solitary functioning kidney (CSFK) predicts a good prognosis, avoiding future kidney injury (KI). This approach reduces follow-up costs significantly.

Area of Science:

  • Pediatric Nephrology
  • Medical Imaging
  • Health Economics

Background:

  • Congenital solitary functioning kidney (CSFK) requires long-term monitoring for kidney injury (KI).
  • Current follow-up protocols may be resource-intensive.
  • Predictive markers for long-term outcomes in CSFK patients are needed.

Purpose of the Study:

  • To evaluate the prognostic value of renal length (RL) > 2 standard deviation scores (SDS) by renal ultrasound (RUS) in identifying CSFK patients at lower risk of KI.
  • To estimate the cost savings of an early RUS algorithm (ERUSA) for CSFK follow-up.

Main Methods:

  • Retrospective analysis of 56 adult patients with CSFK monitored from infancy.
  • Assessment of early RUS (1-3 months) for RL > 2 SDS.
  • Definition of KI as hypertension, proteinuria, or declined renal function.
  • Cost analysis of ERUSA versus current protocols.

Main Results:

  • None of the patients with early RL > 2 SDS developed KI in adulthood.
  • Early RL > 2 SDS was predictive of absence of KI at 1-3 months (OR = infinity) and 1 year (OR = 0.13).
  • ERUSA demonstrated a cost-sparing effect of 38.6% to 55.3% without missing any KI cases.

Conclusions:

  • Renal length > 2 SDS at 1-3 months and 1 year of age predicts a good prognosis in young adulthood for CSFK patients.
  • ERUSA offers a cost-effective follow-up strategy for CSFK patients, maintaining crucial long-term monitoring.

Keywords:
diagnostic ultrasoundkidney function testsoutcome assessmentsolitary kidney

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