{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T10:16:24Z","timestamp":1778667384116,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":98,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Society for Fetal Urology (SFU) grading system is widely used to assess the severity of congenital hydronephrosis (CHN). Distinguishing between Grades 2 and 3 is clinically critical yet diagnostically challenging because of vague definitions. Grades \u2264\u20092 are usually observed, and Grades \u2265\u20093 require closer follow\u2010up; therefore, the 2\u20133 boundary represents a critical threshold. However, the diagnostic accuracy of inexperienced physicians remains unassessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six kidneys (three per grade) with consensus diagnoses by four pediatric nephrology experts were selected as representative cases. Three sagittal static ultrasound images were selected for each kidney. The images were anonymized except for age, sex, and laterality. Twenty\u2010four evaluators (12 first\u2010 or second\u2010year junior residents and 12 non\u2010pediatric senior residents with 3\u20135\u2009years of experience), all without CHN experience, independently graded each case after self\u2010study using published definitions and sample images.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Agreement with the expert consensus was 40% (Fleiss' \u03ba\u2009=\u20090.05). The agreement was 47% for Grade 2 (\u03ba\u2009=\u20090.09) and 33% for Grade 3 (\u03ba\u2009=\u2009\u22120.03). Undergrading of Grade 3 as \u2264\u20092 occurred in 56% of responses, exceeding the overgrading of Grade 2 as \u2265\u20093 (22%). Agreement varied by case, ranging from 54% (Grade 2 kidney \u201ca\u201d) to 25% (Grade 3 kidney \u201cf\u201d). No significant differences were observed between the junior and senior residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inexperienced physicians demonstrated extremely poor reproducibility in distinguishing SFU Grades 2 and 3, with a strong and consistent tendency toward underestimation. Frequent misclassification and marked case\u2010to\u2010case variability underscore the urgent need for improved educational strategies and diagnostic aids.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70393","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:36:22Z","timestamp":1775720182000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiating Society for Fetal Urology Grades 2 and 3 Hydronephrosis: Diagnostic Accuracy of Resident Physicians"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9206-237X","authenticated-orcid":false,"given":"Hiroaki","family":"Kanai","sequence":"first","affiliation":[{"name":"Department of Pediatrics Suwa Central Hospital  Nagano Japan"},{"name":"Department of Pediatrics, Faculty of Medicine University of Yamanashi  Yamanashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4404-8159","authenticated-orcid":false,"given":"Miwa","family":"Goto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine University of Yamanashi  Yamanashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1425-1248","authenticated-orcid":false,"given":"Anna","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine University of Yamanashi  Yamanashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7166-4582","authenticated-orcid":false,"given":"Emi","family":"Sawanobori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine University of Yamanashi  Yamanashi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/iju.14207","article-title":"Pediatric Congenital Hydronephrosis (Ureteropelvic Junction Obstruction): Medical Management Guide","volume":"27","author":"Kohno M.","year":"2020","journal-title":"International Journal of Urology"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/BF02012459","article-title":"Ultrasound Grading of Hydronephrosis: Introduction to the System Used by the Society for Fetal Urology","volume":"23","author":"Fernbach S. 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