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Basuguy E, Önen A, Yalınkaya A, Yayla M. Fetal Anomalilerde Beta-2 Mikroglobulin Düzeyleri ve Pre·Postnatal Ultrasonografi ile Tanı ve Takip. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.574992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruano R, Dunn T, Braun MC, Angelo JR, Safdar A. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr Nephrol 2017; 32:1871-1878. [PMID: 28730376 DOI: 10.1007/s00467-017-3593-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 11/25/2022]
Abstract
The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18 weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30 weeks; prenatal surveillance is recommended. Stage II LUTO is characterized by oligohydramnios/anhydramnios, hyperechogenic kidneys but absent renal cortical cysts or apparent signs of renal dysplasia and favorable fetal urinary biochemistry; fetal vesicoamniotic shunting (VAS) or fetal cystoscopy is indicated to prevent pulmonary hypoplasia and renal failure. Stage III LUTO is oligohydramnios/anhydramnios, hyperechogenic kidneys with cortical cysts and renal dysplasia and unfavorable fetal urinary biochemistry after serial evaluation; fetal vesicoamniotic shunt may prevent severe pulmonary hypoplasia but not renal failure. Stage IV is characterized by intrauterine fetal renal failure, defined by anhydramnios and ultrasound (US) findings suggestive of severe renal dysplasia, and is associated with death in 24 h of life or end-stage renal disease (ESRD) within the first week of life; fetal vesicoamniotic shunt and fetal cystoscopy are not indicated.
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Affiliation(s)
- Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Timothy Dunn
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Michael C Braun
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Adnan Safdar
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
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Nguyen C, Dreux S, Heidet L, Czerkiewicz I, Salomon LJ, Guimiot F, Schmitz T, Tsatsaris V, Boulot P, Rousseau T, Muller F. Fetal serum α
-1 microglobulin for renal function assessment: comparison with β
2-microglobulin and cystatin C. Prenat Diagn 2013; 33:775-81. [DOI: 10.1002/pd.4128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Claire Nguyen
- Biochimie-Hormonologie; Hôpital Robert Debré AP-HP; Paris France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré AP-HP; Paris France
| | - Laurence Heidet
- Nephrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte; Hôpital Necker Enfants-Malades AP-HP; Paris France
| | | | - Laurent J. Salomon
- Gynécologie-Obstétrique, Hôpital Necker Enfants-Malades AP-HP; Université Paris-René Descartes; Paris France
| | - Fabien Guimiot
- Biologie de la Reproduction, Foetopathologie; Hôpital Robert Debré AP-HP; Paris France
| | - Thomas Schmitz
- Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP; Université Paris Diderot; Paris France
| | - Vassilis Tsatsaris
- Gynécologie Obstétrique, Hôpital Cochin, AP-HP; Université Paris Descartes; Paris France
| | - Pierre Boulot
- Gynécologie Obstétrique, Hôpital Arnaud de Villeneuve; Université de Montpellier; Montpellier France
| | - Thierry Rousseau
- Gynécologie Obstétrique, Hôpital du Bocage; Université de Dijon; Dijon France
| | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré AP-HP; Paris France
- Université Paris Versailles-Saint Quentin; Paris France
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Abstract
Congenital urinary tract obstruction (diagnosed antenatally by ultrasound screening) is one of the main causes of end-stage kidney disease in children. The extent of kidney injury in early gestation and the resultant abnormality in kidney development determine fetal outcome and postnatal renal function. Unfortunately, the current approach to diagnostic evaluation of the severity of injury has inherently poor diagnostic and prognostic value because it is based on the assessment of fetal tubular function from fetal urine samples rather than on estimates of the dysplastic changes in the injured developing kidney. To improve the outcome in children with congenital urinary tract obstruction, new biomarkers reflecting these structural changes are needed. Genomic and proteomic techniques that have emerged in the past decade can help identify the key genes and proteins from biological fluids, including amniotic fluid, that might reflect the extent of injury to the developing kidney.
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Tzschoppe A, Rauh M, Goecke TW, Yazdi B, Hart N, Siemer J, Schild RL, Dötsch J. Sex-specific differences in the concentration of tubular parameters in the amniotic fluid of second trimester fetuses. Prenat Diagn 2012; 32:476-9. [DOI: 10.1002/pd.3846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anja Tzschoppe
- Department of Paediatrics and Adolescent Medicine; University of Erlangen-Nuremberg; Erlangen; Germany
| | - Manfred Rauh
- Department of Paediatrics and Adolescent Medicine; University of Erlangen-Nuremberg; Erlangen; Germany
| | - Tamme W. Goecke
- Department of Obstetrics & Gynaecology; University of Erlangen-Nuremberg; Erlangen; Germany
| | - Britta Yazdi
- Department of Obstetrics & Gynaecology; University of Freiburg; Freiburg; Germany
| | - Nicola Hart
- Department of Obstetrics & Gynaecology; Städtisches Klinikum München; Munich; Germany
| | - Jörn Siemer
- Department of Obstetrics & Gynaecology; Ludmillenstift Meppen; Meppen; Germany
| | - Ralf L. Schild
- Department of Obstetrics & Gynaecology; Diakonische Dienste Hannover; Hannover; Germany
| | - Jörg Dötsch
- Department of Paediatrics and Adolescent Medicine; University of Cologne; Cologne; Germany
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Parvex P, Combescure C, Rodriguez M, Girardin E. Is Cystatin C a promising marker of renal function, at birth, in neonates prenatally diagnosed with congenital kidney anomalies? Nephrol Dial Transplant 2012; 27:3477-82. [DOI: 10.1093/ndt/gfs051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Abstract
Congenital urinary tract obstruction is a heterogenous condition with a varying natural history. Accurate diagnosis within the late-first and second trimesters allows for counselling of the parents and planning of multi-disciplinary care for the pregnancy and newborn. Antenatal investigations to predict postnatal renal function are of varying accuracy. However, some factors have been shown to be predictive of poor outcome in terms of renal function at birth and infancy. There is the possibility of in-utero intervention in these fetuses.
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Affiliation(s)
- R K Morris
- Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2TG, UK.
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Abstract
Some anomalies of the kidney and urinary tract evolving in utero may compromise the renal function in the newborn. Early therapeutic options do exist, especially in obstructive nephropathies. The decision depends on a correct evaluation of the foetal enal function and prognosis, which is based on a range of methods: ultrasound echography, biochemical analysis of foetal urine, and, more recently, foetal serum markers such a beta-2 micro globulin. These methods are reviewed.
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Affiliation(s)
- Y Dumez
- Service de médecine foetale, Hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
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Oliveira FR, Barros EG, Magalhães JA. Biochemical profile of amniotic fluid for the assessment of fetal and renal development. Braz J Med Biol Res 2002; 35:215-22. [PMID: 11847525 DOI: 10.1590/s0100-879x2002000200010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Creatinine plays a key role in the function and maturation of fetal kidneys throughout pregnancy. It is important to identify other markers that may help in the diagnosis of renal dysfunction. Our aim was to determine the profile of and the correlation between biochemical markers to be used to assess renal function and maturation of the fetus in the amniotic fluid during pregnancy and to determine the distribution of normal values for creatinine, N-acetyl-beta-D-glucosaminidase (NAG), beta2-microglobulin, glucose, urea, sodium, potassium, phosphorus, calcium, uric acid, albumin, and osmolality in three gestational age groups. This was a cross-section study that assessed 115 samples of amniotic fluid during three different periods of pregnancy, i.e., 13 to 20, 27 to 34, and 36 to 42 weeks. Concentrations of creatinine, NAG, urea, potassium and uric acid increased during pregnancy (P<0.05). Beta2-microglobulin, glucose, sodium, phosphorus, calcium, and albumin concentration and osmolality decreased (P<0.05), whereas beta2-microglobulin, glucose and uric acid presented significant correlations with gestational age and creatinine, respectively (r>0.6, P<0.05). Urea, potassium and phosphorus showed mild correlations with both (r>0.5, P<0.05). NAG, sodium, albumin and osmolality did not show significant correlations (r<0.5, P<0.05). These tests confirmed the important role of creatinine in terms of correlation with gestational age. beta2-Microglobulin, glucose and uric acid were significant as markers of function and maturation of fetal kidneys, whereas NAG did not demonstrate a useful role for the assessment of renal maturation.
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Affiliation(s)
- F R Oliveira
- Divisão de Medicina Materno-Fetal, Departamento de Obstetrícia e Ginecologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Nicolini U, Spelzini F. Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn 2001; 21:964-9. [PMID: 11746150 DOI: 10.1002/pd.212] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are a number of potential biochemical markers that may have some role in predicting renal function postnatally. These include urinary sodium, calcium and beta2-microglobulin. The latter may also be measured in fetal serum. However, the accuracy of these parameters at a point in time is far from perfect as urinary tract obstruction is a progressive disease which may be best defined by repeated observations throughout pregnancy.
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Affiliation(s)
- U Nicolini
- Department of Obstetrics and Gynaecology, Ospedale V. Buzzi, University of Milan, Via Castelvetro 32, 20147 Milan, Italy
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Ciardelli V, Rizzo N, Farina A, Vitarelli M, Boni P, Bovicelli L. Prenatal evaluation of fetal renal function based on serum beta(2)-microglobulin assessment. Prenat Diagn 2001; 21:586-8. [PMID: 11494297 DOI: 10.1002/pd.90] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relationship between fetal renal function (FRF) and fetal serum beta(2)-microglobulin (B2MG) was investigated by comparing its value in 112 unaffected fetuses with that of 23 fetuses presenting with urinary tract malformations (UTM). Fetal serum level of B2MG was totally unrelated to gestational age; its value increased in cases of severe impairment of FRF but was similar to controls in all mild uropathies (p<0.05). Evaluating serum B2MG could be beneficial in fetuses with severe renal damage, but is of no use in unilateral UTM since only the global FRF is tested and not the function of each single kidney.
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Affiliation(s)
- V Ciardelli
- Clinica Ostetrica e Ginecologica e Medicina dell'Eta' Prenatale Ospedale S. Orsola, Università degli Studi di Bologna, Bologna, Italy.
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Dommergues M, Muller F, Ngo S, Hohlfeld P, Oury JF, Bidat L, Mahieu-Caputo D, Sagot P, Body G, Favre R, Dumez Y. Fetal serum beta2-microglobulin predicts postnatal renal function in bilateral uropathies. Kidney Int 2000; 58:312-6. [PMID: 10886576 DOI: 10.1046/j.1523-1755.2000.00167.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Predicting postnatal renal function is crucial for the prenatal evaluation of fetal bilateral uropathies. Prenatal ultrasound can identify intrauterine terminal renal failure, but is not sensitive enough to identify those infants who would survive with an impaired renal function. Because it reflects fetal glomerular filtration, fetal serum beta2-microglobulin is a potential predictor of postnatal renal function. METHODS Fetal serum beta2-microglobulin (beta2m) was assayed in 61 cases of bilateral or low obstructive uropathy, 74 controls, and 17 cases of bilateral renal agenesis, and was correlated with renal function. RESULTS Fetal serum beta2m was 3.2 mg/L (range 1.5 to 4.7) in controls (N = 74), 9.5 mg/L (range 6.7 to 11.3) in bilateral renal agenesis (N = 17), 7 mg/L (5.1 to 10.6) in uropathy in which terminal renal failure resulted in termination of pregnancy (N = 26), and 3.7 mg/L (range 2.3 to 11.2) in live births with uropathy (N = 35). In the latter subgroup, fetal serum beta2m was significantly and positively correlated (r2 = 0.91) with postnatal serum creatinine. All survivors with a postnatal serum creatinine < or =50 micromol/L ha a fetal serum beta2m lower than 5 mg/L. Four of 6 survivors with a postnatal serum creatinine> 50 micromol/L had a fetal serum beta2m greater than 5 mg/L. CONCLUSION Fetal serum beta2-microglobulin is a marker for renal function and predicts postnatal serum creatinine in bilateral or low fetal obstructive uropathy.
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Affiliation(s)
- M Dommergues
- Maternité, Hôpital A. Béclère, and Biochimie, Hôpital A. Paré Paris, France
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Muller F, Bernard MA, Benkirane A, Ngo S, Lortat-Jacob S, Oury JF, Dommergues M. Fetal Urine Cystatin C as a Predictor of Postnatal Renal Function in Bilateral Uropathies. Clin Chem 1999. [DOI: 10.1093/clinchem/45.12.2292] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Sandrine Ngo
- Biochimie, Hôpital Ambroise Paré, 92104 Boulogne, France
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Abstract
Prenatal diagnosis of structural anomalies provides the opportunity to influence the postnatal outcome. The greatest value of antenatal screening is, in fact, the awareness of the urogenital abnormalities, such as presumed UPJ obstruction, so that appropriate investigation and treatment can be offered immediately after birth and before permanent damage occurs owing to obstruction or infection. Crombleholme and coworkers reported that prenatal consultation impacted favorably on outcomes by preventing early termination of pregnancy owing to misconceptions about the existing condition. It also permitted delivery of complex cases in a tertiary care setting, thereby preventing a delay in postnatal management. A systematic approach to the infant in the prenatal and postnatal periods is important. The natural history of prenatally detected hydronephrosis continues to be defined, and there is no ideal test to predict the outcome of UPJ obstruction. Several investigators are evaluating various markers in urine that may help to identify fetuses who require early postnatal intervention. More complete understanding regarding the natural history of unilateral pediatric UPJ obstruction and its response to surgery will not be available until several randomized, prospective clinical studies are completed. The collaborative effort of obstetricians, neonatologists, geneticists, radiologists, and pediatric urologists should provide answers to many questions surrounding prenatally diagnosed UPJ obstruction.
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Affiliation(s)
- P P Reddy
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada
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