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Two Cases of Fetal Lower Urinary Tract Obstruction (LUTO) with Similar Presentations Before But Contrasting Outcomes After Fetoscopic Laser Fulguration of Posterior Urethral Valves. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spaggiari E, Stirnemann JJ, Benedetti S, Dreux S, Salomon LJ, Blanc T, Rosenblatt J, Favre R, Ville Y, Muller F. Comparison of biochemical analysis of fetal serum and fetal urine in the prediction of postnatal renal outcome in lower urinary tract obstruction. Prenat Diagn 2018; 38:555-560. [PMID: 29644715 DOI: 10.1002/pd.5263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the prognostic value of fetal serum biochemistry and fetal urine biochemistry in predicting renal outcome in lower urinary tract obstruction (LUTO). METHODS We retrospectively studied renal outcome following a prenatal diagnosis of LUTO in cases for which both fetal blood and fetal urine were sampled. We classified the renal outcome as either "favorable," when postnatal renal function was normal, or "adverse," in the case of postnatal chronic renal failure or when renal histological lesions were present at autopsy in the case of termination of pregnancy. A prognostic model was constructed for urine and serum separately. β2-Microglobulin was the only remaining independent predictor in fetal urine. β2-Microglobulin in serum and urine were compared by using receiver operating characteristic curves. RESULTS In the 50 cases included, the rate of adverse outcome was 34 of 50(68%): autopsy confirmed severity of renal disease in all 27 cases who underwent termination of pregnancy, and among the 23 live born children, 7 developed renal failure. Fetal serum and urine markers were all significantly associated with renal outcome (P < .01). The receiver operating characteristic curves for fetal serum and fetal urinary β2-microglobulin were similar (area under the curve = 0.908 versus 0.909, P = .96). CONCLUSION Fetal serum biochemistry and fetal urine biochemistry are of similar prognostic value in predicting postnatal renal outcome in fetuses with LUTO.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Sara Benedetti
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Sophie Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Romain Favre
- Obstetrics and Gynecology Department, Hautepierre and CMCO Hospital, Strasbourg, France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Françoise Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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Faure A, Panait N, Panuel M, Alessandrini P, D'Ercole C, Chaumoitre K, Merrot T. Predicting postnatal renal function of prenatally detected posterior urethral valves using fetal diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient determination. Prenat Diagn 2017; 37:666-672. [DOI: 10.1002/pd.5063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/29/2017] [Accepted: 04/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alice Faure
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Nicoleta Panait
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Michel Panuel
- Aix-Marseille Université; Marseille France
- Medical Imaging Department; APHM, CHU Hopital Nord; Marseille France
| | - Pierre Alessandrini
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Claude D'Ercole
- Aix-Marseille Université; Marseille France
- Gynecologic & Obstetrical Department; APHM, CHU Hopital Nord; Marseille France
| | - Kathia Chaumoitre
- Aix-Marseille Université; Marseille France
- Medical Imaging Department; APHM, CHU Hopital Nord; Marseille France
| | - Thierry Merrot
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
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Aulbert W, Kemper MJ. Severe antenatally diagnosed renal disorders: background, prognosis and practical approach. Pediatr Nephrol 2016; 31:563-74. [PMID: 26081158 DOI: 10.1007/s00467-015-3140-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/12/2015] [Accepted: 05/29/2015] [Indexed: 12/20/2022]
Abstract
Nowadays most renal disorders, especially urinary tract malformations and renal cystic disease, are diagnosed antenatally. In cases of severe bilateral disease, intrauterine renal dysfunction may lead to renal oligohydramnios (ROH), resulting in pulmonary hypoplasia which affects perinatal mortality and morbidity as well as the long-term outcome. However, some infants may only have mild pulmonary and renal disease, and advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcome even in those infants with severe ROH. Here, we review the current state of knowledge and clinical experience of patients presenting antenatally with severe bilateral renal disorders and ROH. By addressing underlying mechanisms, intrauterine tools of diagnosis and treatment as well as published outcome data, we hope to improve antenatal counselling and postnatal care. KEY SUMMARY POINTS: 1. Nowadays most renal disorders are diagnosed antenatally, especially urinary tract malformations and renal cystic disease. 2. Severe kidney dysfunction may lead to renal oligohydramnios, which can cause pulmonary hypoplasia and is a risk factor of perinatal mortality and postnatal renal outcome. However, as considerable clinical heterogeneity is present, outcome predictions need to be treated with caution. 3. Advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcomes even in infants with severe renal oligohydramnios. 4. A multidisciplinary approach with specialist input is required when counselling a family with an ROH-affected fetus as the decision-making process is very challenging.
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Affiliation(s)
- Wiebke Aulbert
- Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Markus J Kemper
- Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Yoshizaki CT, Francisco RPV, de Pinho JC, Ruano R, Zugaib M. Renal volumes measured by 3-dimensional sonography in healthy fetuses from 20 to 40 weeks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:421-427. [PMID: 23443182 DOI: 10.7863/jum.2013.32.3.421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to establish reference values for fetal kidney volumes as a function of gestational age, estimated by 3-dimensional sonography using the Virtual Organ Computer-Aided Analysis (VOCAL) technique (GE Healthcare, Kretztechnik, Zipf, Austria). METHODS Volumes of right and left kidneys were assessed in 213 healthy fetuses by 3-dimensional sonography using the VOCAL technique. Inclusion criteria were healthy women with singleton pregnancies, unremarkable comprehensive fetal sonographic findings, well-known gestational age established by first-trimester sonography, and gestational ages between 20 and 40 weeks. Exclusion criteria were patients lost to follow-up and birth weight abnormalities. Each patient was scanned once during pregnancy. Regression analysis was used to calculate unified formulas. RESULTS The mathematical models calculated in the study were as follows: expected right kidney volume = exp[-1.01 + (0.12 × gestational age)]; and expected left kidney volume = exp[-0.90 + (0.12 × gestational age)]. No significant intraobserver or inter-observer variability was observed for the determined volumes. CONCLUSIONS Reference values for right and left fetal kidney volumes throughout gestation using the rotational technique (VOCAL) are described. The use of this technique might aid in further definition of gestational age kidney volume standards to help in defining variations from the norm.
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Affiliation(s)
- Carlos Tadashi Yoshizaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidade de São Paulo, 05403-900 São Paulo-SP, Brazil
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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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Bernardes LS, Salomon R, Aksnes G, Lortat-Jacob S, Benachi A. Ultrasound evaluation of prognosis in fetuses with posterior urethral valves. J Pediatr Surg 2011; 46:1412-8. [PMID: 21763844 DOI: 10.1016/j.jpedsurg.2010.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 11/30/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the ability of prenatal ultrasound markers to predict postnatal renal prognosis in fetuses with posterior urethral valves. METHODS Medical files on fetuses with prenatal diagnosis of posterior urethral valves from 2000 to 2006 were reviewed retrospectively. Data from prenatal follow-up included gestational age at diagnosis, ultrasound renal parenchyma evaluation, and presence and time of oligohydramnios onset. Prenatal parameters studied were correlated to postnatal renal function. RESULTS Thirty-one male fetuses were included. Six pregnancies were terminated. Of the remaining 25 pregnancies that were continued, 4 children had abnormal creatine and 21 normal creatinine levels at follow-up. Presence and time of oligohydramnios onset did not differ between groups (P = .43). Ultrasound detected bilateral renal abnormalities in 3 fetuses (75%) with altered renal function, and 10 fetuses (55%) with normal creatinine, at follow-up. CONCLUSIONS None of the ultrasound parameters evaluated were able to reliably predict postnatal renal function.
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Ruano R, Duarte S, Bunduki V, Giron AM, Srougi M, Zugaib M. Fetal cystoscopy for severe lower urinary tract obstruction--initial experience of a single center. Prenat Diagn 2010; 30:30-9. [PMID: 19967749 DOI: 10.1002/pd.2418] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report the experience with fetal cystoscopy and laser fulguration of posterior urethral values (PUV) for severe lower urinary tract obstruction (LUTO). METHODS Between July 2006 and December 2008, fetal cystoscopy was offered to 23 patients whose fetuses presented with severe LUTO, favorable urinary analysis and gestational age <26 weeks. Fetal urinary biochemistry was evaluated before and after cystoscopy. All infants were followed 6-12 months after birth. Abnormal renal function was defined when serum creatinine higher than 50 micromol/L (2 Standard Deviation) or the necessity of dialysis or renal transplantation. Autopsy was always performed whenever fetal or neonatal deaths occurred. RESULTS Eleven patients decided to undergo fetal therapy and 12 elected to continue with expectant observation. There was no difference between both groups in gestation age at diagnosis and referral examinations. Urethral atresia was diagnosed in 4/11 (36.4%) fetuses by fetal cystoscopy. At 26 weeks, fetuses that were managed expectantly presented with worse urinary biochemistry results (p < 0.05). Survival rates and percentage of infants with normal renal function were significantly higher in the cystoscopic group than in the expectant group (p < 0.05). CONCLUSIONS Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the PUV under cystoscopy may prevent renal function deterioration improving postnatal outcome.
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Affiliation(s)
- Rodrigo Ruano
- Obstetrics Department, Faculty of Medicine, São Paulo University, Rua Valentim Magalhães 100, São Paulo, SP, Brazil.
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Kemper MJ, Mueller-Wiefel DE. Prognosis of antenatally diagnosed oligohydramnios of renal origin. Eur J Pediatr 2007; 166:393-8. [PMID: 17205244 DOI: 10.1007/s00431-006-0368-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 11/07/2006] [Indexed: 12/12/2022]
Abstract
Although clinical outcome data on fetuses with oligohydramnios of renal origin are scarce, prognosis is regarded as poor due to a high risk of renal dysfunction and pulmonary hypoplasia. This review aims to summarize the current knowledge and clinical experience with patients presenting antenatally with renal oligohydramnios. By reviewing the underlying mechanisms, complications, and outcome data, we hope to further improve antenatal counseling and postnatal care. We conclude that prognosis of ROH has changed in recent years. While early data before the introduction of sophisticated neonatal intensive care and renal replacement therapy indicated a poor prognosis, nowadays, a much more optimistic prognosis of children after renal oligohydramnios can be expected from the recent publications in the literature.
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Affiliation(s)
- Markus J Kemper
- Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Morris RK, Quinlan-Jones E, Kilby MD, Khan KS. Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn 2007; 27:900-11. [PMID: 17610312 DOI: 10.1002/pd.1810] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of analysis of fetal urine in the prediction of poor postnatal renal function in cases of congenital urinary tract obstruction. METHODS A systematic review was performed. We conducted extensive electronic searches (database inception-2006). The reference lists of articles obtained were searched for any further articles. Two reviewers independently selected the articles in which the accuracy of fetal urinalysis was evaluated to predict poor postnatal renal function. There were no language restrictions. Data were extracted on study characteristics, quality and results, to construct 2 x 2 tables. Likelihood ratios for positive (LR+) and negative (LR-) test results were generated for the different fetal urinary analytes at various thresholds. RESULTS There were 23 articles that met the selection criteria, including a total of 572 women and 63 2 x 2 tables. The two most accurate tests were calcium > 95th centile for gestation (LR + 6.65, 0.23-190.96; LR - 0.19, 0.05-0.74) and sodium > 95th centile for gestation (LR + 4.46, 1.71-11.6; LR - 0.39, 0.17-0.88). beta(2)-microglobulin was found to be less accurate (LR + 2.92, 1.28-6.69; LR - 0.53, 0.24-1.17). CONCLUSION The current evidence demonstrates that none of the analytes of fetal urine investigated so far can be shown to yield clinically significant accuracy to predict poor postnatal renal function.
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Affiliation(s)
- R K Morris
- Division of Reproductive and Child Health, Birmingham Women's Hospital, University of Birmingham, Birmingham, UK
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