{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:38:52Z","timestamp":1792593532707,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess interobserver agreement in the evaluation of the fetal urinary tract in fetuses with urinary tract dilatation (UTD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study evaluating interobserver agreement on renal tract features using third-trimester renal ultrasound images of fetuses with UTD. Two fetal medicine specialists and two pediatric nephrologists independently and systematically assessed ultrasound features of the fetal renal parenchyma and urinary bladder, as well as the Society for Fetal Urology (SFU) and the ONEN grading systems. Interobserver variability was analyzed using Cohen\u2019s kappa statistics and intraclass correlation coefficients (ICC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1639 ultrasound images from 144 fetuses with antenatal UTD were analyzed. Slight to moderate agreement was observed for most renal ultrasound parameters, including cortico-medullary differentiation (\u03ba\u2009=\u20090.28\u20130.50), renal echogenicity (\u03ba\u2009=\u20090.18\u20130.45), and cortical cysts (\u03ba\u2009=\u20090.02\u20130.15). A similar pattern was observed for the subjective assessment of bladder features. In contrast, both the SFU and the ONEN grading system demonstrated moderate to substantial agreement, with ICC values ranging from 0.61 to 0.73 and 0.55 to 0.66, respectively, and kappa values from 0.38 to 0.63 and 0.48 to 0.67.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Significant interobserver variability exists in the interpretation of commonly used prenatal ultrasound features for evaluating the fetal urinary tract and predicting postnatal outcomes in UTD. The SFU and the ONEN grading systems improved agreement, supporting the need for standardized ultrasound assessment tools to enhance prenatal counseling and antenatal management in fetuses with UTD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-026-07592-0","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:42:45Z","timestamp":1792590165000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interobserver agreement in prenatal ultrasound assessment of fetal urinary tract dilatation"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2967-4775","authenticated-orcid":false,"given":"Silvia","family":"Spinnato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0789-7329","authenticated-orcid":false,"given":"Lauret A. M.","family":"Brinkman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-9973","authenticated-orcid":false,"given":"Leonie K.","family":"Duin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0330-4283","authenticated-orcid":false,"given":"Valentina","family":"Gracchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4647-9312","authenticated-orcid":false,"given":"Charlotte M. H. H. T.","family":"Bootsma-Robroeks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1894-0626","authenticated-orcid":false,"given":"Caterina M.","family":"Bilardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3915-8609","authenticated-orcid":false,"given":"Sanne J.","family":"Gordijn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-4984","authenticated-orcid":false,"given":"Federica","family":"Fontanella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"7592_CR1","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1080\/00016340701714802","volume":"86","author":"S Ek","year":"2007","unstructured":"Ek S, Lidefeldt K, Varricio L (2007) Fetal hydronephrosis; prevalence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand 86:1463\u20131466. https:\/\/doi.org\/10.1080\/00016340701714802","journal-title":"Acta Obstet Gynecol Scand"},{"key":"7592_CR2","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/S1879-5226(10)60024-3","volume":"21","author":"Y-C Chen","year":"2010","unstructured":"Chen Y-C, Lin VC, Yu T-J (2010) Antenatal hydronephrosis. Urol Sci 21:109\u2013112. https:\/\/doi.org\/10.1016\/S1879-5226(10)60024-3","journal-title":"Urol Sci"},{"key":"7592_CR3","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.ucl.2018.06.011","volume":"45","author":"A Balthazar","year":"2018","unstructured":"Balthazar A, Herndon CDA (2018) Prenatal urinary tract dilatation. Urol Clin North Am 45:641\u2013657. https:\/\/doi.org\/10.1016\/j.ucl.2018.06.011","journal-title":"Urol Clin North Am"},{"key":"7592_CR4","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.jpeds.2004.02.035","volume":"144","author":"K Ismaili","year":"2004","unstructured":"Ismaili K, Avni FE, Martin Wissing K, Hall M (2004) Long-term clinical outcome of infants with mild and moderate fetal pyelectasis: validation of neonatal ultrasound as a screening tool to detect significant nephrouropathies. J Pediatr 144:759\u2013765. https:\/\/doi.org\/10.1016\/j.jpeds.2004.02.035","journal-title":"J Pediatr"},{"key":"7592_CR5","doi-asserted-by":"publisher","first-page":"103","DOI":"10.3389\/fped.2019.00103","volume":"7","author":"B Chiodini","year":"2019","unstructured":"Chiodini B, Ghassemi M, Khelif K, Ismaili K (2019) Clinical outcome of children with antenatally diagnosed hydronephrosis. Front Pediatr 7:103. https:\/\/doi.org\/10.3389\/fped.2019.00103","journal-title":"Front Pediatr"},{"key":"7592_CR6","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1542\/peds.2006-0120","volume":"118","author":"RS Lee","year":"2006","unstructured":"Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586\u2013593. https:\/\/doi.org\/10.1542\/peds.2006-0120","journal-title":"Pediatrics"},{"key":"7592_CR7","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1111\/j.1471-0528.2009.02194.x","volume":"116","author":"R Morris","year":"2009","unstructured":"Morris R, Malin G, Khan K, Kilby M (2009) Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG 116:1290\u20131299. https:\/\/doi.org\/10.1111\/j.1471-0528.2009.02194.x","journal-title":"BJOG"},{"key":"7592_CR8","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1002\/uog.18990","volume":"52","author":"F Fontanella","year":"2018","unstructured":"Fontanella F, Duin LK, Adama van Scheltema PN et al (2018) Prenatal diagnosis of LUTO: improving diagnostic accuracy. Ultrasound Obstet Gynecol 52:739\u2013743. https:\/\/doi.org\/10.1002\/uog.18990","journal-title":"Ultrasound Obstet Gynecol"},{"key":"7592_CR9","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1007\/BF02012459","volume":"23","author":"SK Fernbach","year":"1993","unstructured":"Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr Radiol 23:478\u2013480. https:\/\/doi.org\/10.1007\/BF02012459","journal-title":"Pediatr Radiol"},{"key":"7592_CR10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.jpurol.2010.02.205","volume":"6","author":"HT Nguyen","year":"2010","unstructured":"Nguyen HT, Herndon CDA, Cooper C et al (2010) The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6:212\u2013231. https:\/\/doi.org\/10.1016\/j.jpurol.2010.02.205","journal-title":"J Pediatr Urol"},{"key":"7592_CR11","doi-asserted-by":"publisher","first-page":"458","DOI":"10.3389\/fped.2020.00458","volume":"8","author":"A Onen","year":"2020","unstructured":"Onen A (2020) Grading of hydronephrosis: an ongoing challenge. Front Pediatr 8:458. https:\/\/doi.org\/10.3389\/fped.2020.00458","journal-title":"Front Pediatr"},{"key":"7592_CR12","doi-asserted-by":"publisher","first-page":"e484","DOI":"10.1016\/j.crad.2013.03.023","volume":"68","author":"S-Y Kim","year":"2013","unstructured":"Kim S-Y, Kim M-J, Yoon CS et al (2013) Comparison of the reliability of two hydronephrosis grading systems: the society for foetal urology grading system vs. the onen grading system. Clin Radiol 68:e484\u2013e490. https:\/\/doi.org\/10.1016\/j.crad.2013.03.023","journal-title":"Clin Radiol"},{"key":"7592_CR13","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159. https:\/\/doi.org\/10.2307\/2529310","journal-title":"Biometrics"},{"key":"7592_CR14","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo TK, Li MY (2016) A Guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155\u2013163. https:\/\/doi.org\/10.1016\/j.jcm.2016.02.012","journal-title":"J Chiropr Med"},{"key":"7592_CR15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1038\/ki.1997.299","volume":"52","author":"F Da\u00efkha-Dahmane","year":"1997","unstructured":"Da\u00efkha-Dahmane F, Dommergues M, Muller F et al (1997) Development of human fetal kidney in obstructive uropathy: correlations with ultrasonography and urine biochemistry. Kidney Int 52:21\u201332. https:\/\/doi.org\/10.1038\/ki.1997.299","journal-title":"Kidney Int"},{"key":"7592_CR16","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1002\/uog.27684","volume":"64","author":"HJ Mustafa","year":"2024","unstructured":"Mustafa HJ, Khalil A, Johnson S et al (2024) Fetal lower urinary tract obstruction: international Delphi consensus on management and core outcomes set. Ultrasound Obstet Gynecol 64:635\u2013650. https:\/\/doi.org\/10.1002\/uog.27684","journal-title":"Ultrasound Obstet Gynecol"},{"key":"7592_CR17","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1002\/uog.6413","volume":"34","author":"LS Bernardes","year":"2009","unstructured":"Bernardes LS, Aksnes G, Saada J et al (2009) Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol 34:419\u2013423. https:\/\/doi.org\/10.1002\/uog.6413","journal-title":"Ultrasound Obstet Gynecol"},{"key":"7592_CR18","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/j.juro.2006.03.079","volume":"176","author":"DE Coplen","year":"2006","unstructured":"Coplen DE, Austin PF, Yan Y et al (2006) The magnitude of fetal renal pelvic dilatation can identify obstructive postnatal hydronephrosis, and direct postnatal evaluation and management. J Urol 176:724\u2013727. https:\/\/doi.org\/10.1016\/j.juro.2006.03.079","journal-title":"J Urol"},{"key":"7592_CR19","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/j.juro.2009.03.025","volume":"182","author":"D-Y Kim","year":"2009","unstructured":"Kim D-Y, Mickelson JJ, Helfand BT et al (2009) Fetal pyelectasis as predictor of decreased differential renal function. J Urol 182:1849\u20131853. https:\/\/doi.org\/10.1016\/j.juro.2009.03.025","journal-title":"J Urol"},{"key":"7592_CR20","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/s00247-007-0695-7","volume":"38","author":"M Riccabona","year":"2008","unstructured":"Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138\u2013145. https:\/\/doi.org\/10.1007\/s00247-007-0695-7","journal-title":"Pediatr Radiol"},{"key":"7592_CR21","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1002\/jum.15133","volume":"39","author":"CP Nelson","year":"2020","unstructured":"Nelson CP, Heller HT, Benson CB et al (2020) Interobserver reliability of the antenatal consensus classification system for urinary tract dilatation. J Ultrasound Med 39:551\u2013557. https:\/\/doi.org\/10.1002\/jum.15133","journal-title":"J Ultrasound Med"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07592-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-026-07592-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-026-07592-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:42:45Z","timestamp":1792590165000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-026-07592-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":21,"alternative-id":["7592"],"URL":"https:\/\/doi.org\/10.1007\/s00467-026-07592-0","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"30 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}