A clinical nomogram for predicting postoperative renal function improvement in children with UPJO

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Innovation

Background:

• Ureteropelvic junction obstruction (UPJO) is a primary cause of congenital hydronephrosis in children.
• Pyeloplasty is effective, but predicting postoperative renal function improvement remains challenging.
• Validated tools for estimating functional recovery post-pyeloplasty are limited.

Purpose of the Study:

• To develop and externally validate a predictive nomogram for postoperative renal function improvement in pediatric UPJO patients undergoing pyeloplasty.
• To provide clinicians with a tool for better preoperative counseling and expectation setting.

Main Methods:

• Retrospective two-center study of 178 pediatric patients (<16 years) undergoing laparoscopic pyeloplasty.
• Collected clinical, imaging, and laboratory data, including preoperative and postoperative 99mTc-DTPA dynamic renal scintigraphy.
• Developed a nomogram using LASSO and logistic regression, incorporating predictors like serum urea, age, and preoperative differential renal function (DRF).

Main Results:

• The final nomogram included gender, age, preoperative affected-side DRF, and serum urea.
• The nomogram demonstrated strong predictive performance with AUCs of 0.836 (development) and 0.880 (validation).
• Lower preoperative DRF was associated with more pronounced functional improvement post-pyeloplasty.

Conclusions:

• The developed nomogram effectively predicts individualized probabilities of renal function improvement after pyeloplasty in children with UPJO.
• This tool can aid in preoperative patient counseling and managing expectations regarding functional recovery.
• Most pediatric UPJO patients experience stable or improved renal function post-pyeloplasty, particularly those with lower initial DRF.