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.

Elementos sobre indización y búsqueda de la información por medio de vocabularios controlados en bases de datos biomédicas / Elements on indexing and search of information using controlled vocabularies in biomedical databases

Desde las perspectivas de la alfabetización informacional y la búsqueda de la información, existe la imperiosa necesidad de conocer algunos elementos básicos sobre los procesos de indización y recuperación de la información antes de introducir a los alumnos en la búsqueda de la información en bases de datos que ofrecen la posibilidad de explorar sus colecciones mediante vocabularios controlados. Se define la indización y la búsqueda de información; se exponen sus elementos, nociones e importancia y se estudian los tesauros MeSH y su versión en español: el DeCS. El conocimiento de algunos elementos teóricos y prácticos sobre los procesos de indización y recuperación de la información es un escalón importante en la correcta comprensión de la actividad de búsqueda en bases de datos bibliográficas que utilizan vocabularios controlados.

From the perspective of the literacy and search of the information, there is an urgent need of know some basic elements on the indexing and retrieval of the information before to introduce students in the information search in the databases offering the chance to explore the collections by means of controlled vocabularies. Indexing and search of information is defined, its elements, notions and significance are exposed and MeSH thesaurus is studied and its Spanish version. The knowledge of some theoretical and practical elements on the indexing and retrieval of information is a significant step in the appropriate understanding of the activity of search in bibliographic databases using controlled vocabularies.