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Nishi K, Ozawa K, Kamei K, Sato M, Ogura M, Muromoto J, Sugibayashi R, Isayama T, Ito Y, Wada S, Yokoo T, Ishikura K. Long-term Outcomes, Including Fetal and Neonatal Prognosis, of Renal Oligohydramnios: A Retrospective Study over 22 Years. J Pediatr 2024:114151. [PMID: 38880380 DOI: 10.1016/j.jpeds.2024.114151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death. STUDY DESIGN This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed. RESULTS Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (odds ratio 1.16, 95% confidence interval (CI) 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (odds ratio 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, one case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death. CONCLUSION Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Jin Muromoto
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rika Sugibayashi
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.
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Schulz AM, Lauten A, Lehmann T, Proquitté H, Eckoldt F, Weigel F, Mentzel HJ, Schneider U, John-Kroegel U. Amniotic fluid content in children with kidney and urinary tract anomalies determines pre- and postnatal development. Pediatr Nephrol 2023; 38:3635-3643. [PMID: 37219638 PMCID: PMC10514154 DOI: 10.1007/s00467-023-05988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Renal oligohydramnios (ROH) describes an abnormally low volume of amniotic fluid (AF) during pregnancy. ROH is mostly caused by congenital fetal kidney anomalies. The ROH diagnosis frequently implies an increased risk of peri- and postnatal fetal mortality and morbidity. The present study aimed to evaluate the impact of ROH on pre-and postnatal development in children with congenital kidney anomalies. METHODS This retrospective study included 168 fetuses with anomalies in the kidney and urinary tract. Based on the amount of AF measured by ultrasound, patients were divided into three groups: normal amniotic fluid (NAF), amniotic fluid in the lower normal range (LAF), and ROH. These groups were compared with respect to prenatal sonographic parameters, perinatal outcomes, and postnatal outcomes. RESULTS Among the 168 patients with congenital kidney anomalies, 26 (15%) had ROH, 132 (79%) had NAF, and 10 (6%) had LAF. Of the 26 families affected by ROH, 14 (54%) decided to terminate pregnancy. Of 10 live-born children in the ROH group, 6 (60%) survived the observation time; of these, 5/6 presented with chronic kidney disease, stages I-III, at their last examination. The main differences in postnatal development between the ROH group and the NAF and LAF groups were: restricted height and weight gain, respiratory issues, complicated feeding, and the presence of extrarenal malformations. CONCLUSIONS ROH is not a mandatory indicator of severe postnatal kidney function impairment. However, children with ROH have complicated peri-and postnatal periods, due to the presence of concomitant malformations, which must be considered in prenatal care. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anne Mareike Schulz
- Department of Pediatrics, Pediatric Nephrology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Thuringia, Germany.
| | - Angela Lauten
- Department of Obstetrics and Gynecology, University Hospital Jena, Jena, Thuringia, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Jena, Jena, Thuringia, Germany
| | - Hans Proquitté
- Department of Pediatrics, Section of Neonatology, University Hospital Jena, Jena, Thuringia, Germany
| | - Felicitas Eckoldt
- Department of Pediatric Surgery, University Hospital Jena, Jena, Thuringia, Germany
| | - Friederike Weigel
- Department of Pediatrics, Pediatric Nephrology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Thuringia, Germany
| | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Hospital Jena, Jena, Thuringia, Germany
| | - Uwe Schneider
- Department of Obstetrics and Gynecology, University Hospital Jena, Jena, Thuringia, Germany
| | - Ulrike John-Kroegel
- Department of Pediatrics, Pediatric Nephrology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Thuringia, Germany
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Sourouni M, Haisch L, Oelmeier K, Möllers M, Willy D, Sondern K, Köster H, Steinhard J, Sandkötter J, Klockenbusch W, Schmitz R, Potratz J. Observed to expected lung area to head circumference ratio (O/E LHR) in fetuses with congenital anomalies of the kidney and urinary tract (CAKUT): assessment and evaluation as predictive factor for acute postnatal outcome-a single center study. Front Pediatr 2023; 11:1145907. [PMID: 37404558 PMCID: PMC10317208 DOI: 10.3389/fped.2023.1145907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction To assess the observed to expected lung area to head circumference ratio (O/E LHR) in fetuses with congenital anomalies of the kidney and urinary tract (CAKUT) and to explore its value as a potential predictive factor for postnatal outcome. Methods A retrospective single-center study was conducted on pregnancies complicated by CAKUT between 2007 and 2018. The lung-to-head ratio (LHR) was calculated for each fetus by two independent observers. Correlations between O/E LHR and various perinatal outcome factors were assessed with Spearman's rank correlation. Furthermore, nominal logistic regression was performed to assess O/E LHR as predictive factor for respiratory distress in newborn. Results Of 64 pregnancies complicated by CAKUT, 23 were terminated. In the 41 cases of continuation of pregnancy, newborn presenting respiratory distress with need for respiratory support in the delivery room showed earlier gestational age at onset of amniotic fluid abnormalities and at birth. Although median O/E LHR and median single deepest pocket (SDP) of amniotic fluid were significantly smaller in newborn that did develop respiratory distress with need of respiratory support in the delivery room, neither O/E LHR nor SDP were accurate predictors for the development of respiratory distress. Conclusions Our data show that O/E LHR alone cannot serve as a predictive marker for fetal outcome in pregnancies complicated by CAKUT, though it might still be a helpful parameter together with detailed renal ultrasound evaluation, onset of amniotic fluid abnormality and SDP, particularly in its extreme values.
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Affiliation(s)
- M. Sourouni
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
- Department of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Heidelberg, Germany
| | - L. Haisch
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - K. Oelmeier
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M. Möllers
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - D. Willy
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - K. Sondern
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - H. Köster
- Gynaecologist’s Office of Dr. Natalia Ulrich, Berlin, Germany
| | - J. Steinhard
- Department of Fetal Cardiology, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - J. Sandkötter
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - W. Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - R. Schmitz
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - J. Potratz
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
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Plaud Gonzalez AM, Joseph C, Stover SR, Nassr A, Koh CJ, Angelo JR, Braun MC. Fetal Nephrology: A Quaternary Care Center Experience. KIDNEY360 2023; 4:333-340. [PMID: 36996300 PMCID: PMC10103341 DOI: 10.34067/kid.0004782022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
Key Points Specialized fetal centers see a highly complex subset of patients with CAKUT with a predominance of complex or syndromic disease. The mortality rate for fetuses with complex developmental anomalies and CAKUTs or bilateral CAKUTs is high. Prenatal genetic testing was highly variable with limited diagnostic utility while focused postnatal genetic testing had much higher yield. Background Congenital anomalies of the kidney and urinary tract (CAKUTs) represent 15%–20% of prenatally diagnosed abnormalities. Maternal characteristics, the frequency of various forms of kidney disease including CAKUT referred for prenatal nephrology consultation, and their perinatal outcomes are less well defined. Methods A retrospective chart review was performed of fetal CAKUT and other forms of kidney disease referred for prenatal nephrology consults at Texas Children's Hospital Fetal Center from January 1, 2012, to December 31, 2018. Results Two hundred seventeen prenatal nephrology consultations were performed during the study period, representing 4.7% of total Fetal Center referrals at a mean estimated gestational age of 25.2±5.7 weeks. Maternal characteristics were as follows: The mean age was 29.3±5.6 years; 14% had advanced maternal age; 10% had a family history of CAKUT or ESKD; 5% had diabetes mellitus; and 5% of pregnancies were in vitro fertilization-assisted. Fetal characteristics were as follows: 62.7% of fetuses were male and 16% had CAKUT associated with multiple congenital anomalies. The most common prenatal diagnoses were lower urinary tract obstruction in 71 (32.7%), unilateral renal agenesis or multicystic dysplastic kidney (MCDK) in 52 (24.9%), bilateral agenesis or MCDK in 22 (10.1%), and bilateral cystic kidney disease in 19 (8.8%). Seventy-six percent of patients received genetic counseling. One hundred forty-one (64.9%) patients had some form of prenatal genetic testing with a positivity rate of 5.7%. Postnatal characteristics were as follows: 61 (28.1%) patients were seen in prenatal consultation only and no follow-up was available. Of the remaining 156 pregnancies, 136 (86.3%) were viable and delivered at a mean gestational age of 35.2±3.8 weeks. Of these, 100 (64%) survived to discharge. Additional postnatal genetic testing was obtained in 27 infants with a positivity rate of 59%. Conclusions Overall perinatal mortality for this cohort as a whole was high (35.8%). While prenatal genetic testing had a limited diagnostic utility, targeted postnatal genetic testing had a much higher diagnostic yield.
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Affiliation(s)
- Auda M. Plaud Gonzalez
- Section of Nephrology, Department of Pediatrics, University of Puerto Rico School of Medicine
| | - Catherine Joseph
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine
| | - Samantha R. Stover
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
| | - Ahmed Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine
| | - Chester J. Koh
- Division of Pediatric Urology, Scott Department of Urology, Baylor College of Medicine
| | - Joseph R. Angelo
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine
- Department of Obstetrics and Gynecology, Baylor College of Medicine
| | - Michael C. Braun
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine
- Department of Obstetrics and Gynecology, Baylor College of Medicine
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Predictive factors for survival in patients with oligohydramnios secondary to antenatal kidney disease. Pediatr Nephrol 2022; 38:1783-1792. [PMID: 36409365 DOI: 10.1007/s00467-022-05800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Renal oligohydramnios (ROH) is caused by bilateral congenital abnormalities, either of renal parenchymal or obstructive origin. ROH is a poor prognostic factor of neonatal survival; lung hypoplasia is reported to be the main cause of mortality. We aimed to describe the fetal morbidity and pre- and postnatal mortality in case of ROH due to renal congenital pathologies and to find predictive risk factors for morbidity and mortality. METHODS All data were collected in Trousseau Hospital in the obstetric, neonatology, and pediatric nephrology units, from 2008 to 2020. RESULTS We included 66 fetuses with renal parenchymal pathologies posterior urethral valves (PUV) (N = 25), bilateral kidney agenesis (N = 10), hypodysplasia (N = 16), and polycystic kidney disease (N = 10) causing oligohydramnios identified on antenatal ultrasound. Total pre- and postnatal mortality was 76% (50/66). Mortality, excepting termination of pregnancy (TOP), was 65%. The presence of pneumomediastinum and pneumothorax was not different in survivors and non-survivors. Fetuses with kidneys having features of hypodysplasia on ultrasound at T2 and those with oligohydramnios before 32 weeks GA had a higher risk of death. There was a significant difference in plasma creatinine of the surviving patients compared to the deceased patients, from day 3 onwards (183 µmol/L [88; 255] vs. 295 µmol/L [247; 326]; p = 0.038). CONCLUSIONS The main differences between survivors and non-survivors among patients with "renal oligohydramnios" were oligohydramnios detection before 32 weeks GA, dysplasia detection on the second trimester ultrasound, and increase of serum creatinine from day 3 onwards. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Dathe K, Frank J, Padberg S, Hultzsch S, Beck E, Schaefer C. Fetal adverse effects following NSAID or metamizole exposure in the 2nd and 3rd trimester: an evaluation of the German Embryotox cohort. BMC Pregnancy Childbirth 2022; 22:666. [PMID: 36028798 PMCID: PMC9413886 DOI: 10.1186/s12884-022-04986-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAID) are frequently used to treat pain, fever and inflammatory conditions. Due to evidenced fetotoxicity, treatment with NSAID and metamizole should be avoided in the 3rd trimester of pregnancy. There is an ongoing debate on fetotoxic risk of 2nd trimester use which is why we have conducted this study. METHODS In this observational cohort study outcome of pregnancies with NSAID and/or metamizole exposure in the 2nd and/or 3rd trimester (study cohort n = 1092) was compared with pregnancies exposed to NSAID and/or metamizole in the 1st trimester only (comparison cohort, n = 1154). The WHO-UMC system was used to assess causality between study medication and study endpoints. Prenatal study endpoints were constriction of ductus arteriosus Botalli, oligohydramnios, late spontaneous abortion (SAB) or stillbirth. Postnatal study endpoints were patent ductus arteriosus (PDA), anomalies of the right heart ventricle, primary pulmonary hypertension (PPHT), and neonatal impairment of kidney function. RESULTS Ductus arteriosus constriction was diagnosed in 5/1092 (0.5%) in the study cohort versus 0/1154 pregnancies in the comparison cohort. In one fetus, ductus arteriosus constriction and oligohydramnios occurred already in the late 2nd trimester after long-term NSAID exposure. Oligohydramnios was diagnosed in 41/1092 (3.8%) in the study cohort versus 29/1154 (2.5%) cases in the comparison cohort [RR, 1.5 (95% CI 0.9-2.4)]. Limited to 2nd trimester, oligohydramnios occurred in 8/904 (0.9%) versus 2/1154 (0.2%) pregnancies [RR, 5.1 (95% CI 1.1-24.0)]. At least in four of the 2nd trimester exposed pregnancies NSAID exposure lasted several weeks. Late SAB or stillbirth occurred in 14/1092 (1.3%) versus 17/1154 (1.5%). Postnatal cardiovascular or renal pathology did not differ between the cohorts. CONCLUSIONS NSAID use in the 2nd trimester limited to a few days does not appear to pose a relevant risk. Use for longer periods in the advanced 2nd trimester, however, may cause oligohydramnios and ductus arteriosus constriction similar to effects observed after 3rd trimester use.
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Affiliation(s)
- Katarina Dathe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Johanna Frank
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany
| | - Stephanie Padberg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany
| | - Stefanie Hultzsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany
| | - Evelin Beck
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Embryotox), Augustenburger Platz 1, 13353, Berlin, Germany
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Slagle C, Schuh M, Grisotti G, Riddle S, Reddy P, Claes D, Lim FY, VanderBrink B. In utero renal failure. Semin Pediatr Surg 2022; 31:151195. [PMID: 35725056 DOI: 10.1016/j.sempedsurg.2022.151195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States.
| | - Meredith Schuh
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Gabriella Grisotti
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Stefanie Riddle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Donna Claes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
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Systematic review on outcomes used in clinical research on autosomal recessive polycystic kidney disease-are patient-centered outcomes our blind spot? Pediatr Nephrol 2021; 36:3841-3851. [PMID: 34386850 PMCID: PMC8599334 DOI: 10.1007/s00467-021-05192-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) is a rare severe hepatorenal disease. Survivors of pulmonary hypoplasia and patients with milder presentations often achieve long-term survival but frequently require kidney and/or liver transplantation. OBJECTIVE To examine the use of clinical, surrogate and patient-centered outcomes in studies on ARPKD with special attention to core outcomes of the Standardized Outcomes in NephroloGy project for children with chronic kidney disease (SONG-Kids). DATA SOURCES AND STUDY ELIGIBILITY CRITERIA A systematic MEDLINE literature search identified 367 ARPKD studies published since 1990; however, of these 134 were excluded because they did not report any clinical outcomes (e.g. only histopathological, genetic, protein structure or radiological markers), 19 studies because they only included prenatal patients and 138 because they were case reports with ≤ 3 patients. STUDY APPRAISAL Seventy-six eligible studies were examined for study type, size, intervention, and reported outcomes by organ system and type, including all SONG-kids tier 1-3 outcomes. PARTICIPANTS There were 3231 patient-reports of children and adults with ARPKD. RESULTS The overwhelming majority of studies reported clinical and surrogate outcomes (75/76 (98%) and 73/76 (96%)), but only 11/76 (14%) examined patient-centered outcomes and only 2/76 (3%) used validated instruments to capture them. Of the SONG-Kids core outcomes, kidney function was reported almost universally (70/76 (92%), infection and survival in three quarters (57/76 (75%), 55/76 (72%)) and measures of life participation (including neurological impairment) only rarely and inconsistently (16/76 (21%)). LIMITATIONS Thirty studies (39%) were of low quality as they were either narrative case reports (n = 14, 18%) and/or patients with ARPKD were an indistinguishable subgroup (n = 18, 24%). Only 28 trials compared interventions, but none were randomized. CONCLUSIONS AND IMPLICATIONS Studies that reported clinical outcomes in ARPKD usually covered the core outcome domains of kidney function, infections, and survival, but measures of life participation and patient-centered outcomes are distinctly lacking and require more attention in future trials. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Cheung CY, Brace RA. Altered proteomics profile in the amnion of patients with oligohydramnios. Physiol Rep 2020; 8:e14381. [PMID: 32109340 PMCID: PMC7048322 DOI: 10.14814/phy2.14381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/25/2020] [Accepted: 02/05/2020] [Indexed: 12/23/2022] Open
Abstract
In pregnancy, idiopathic oligohydramnios is an obstetrical complication that compromises maternal health with poor perinatal outcome. Effective therapeutic treatment of this condition has been hampered by the unknown etiology and lack of understanding of cellular and molecular mechanisms that underlie idiopathic oligohydramnios. Amniotic fluid volume (AFV) is determined by intramembranous (IM) transport of amniotic fluid across the amnion and this pathway is regulated to maintain AFV within the normal range. To gain understanding of the causes of idiopathic oligohydramnios, we performed proteomics analysis of the human amnion to investigate the changes in protein expression profiles of cellular transport pathways and regulators in patients with oligohydramnios. Placental amnions from five patients with normal pregnancies and five patients with oligohydramnios were subjected to proteomics experiments followed by bioinformatics analysis. Using Ingenuity Pathway Analysis (IPA) software, five categories of biological functions and multiple canonical pathways within each category were revealed. The top differentially expressed proteins that participate in mediating these pathways were identified. The functional pathways activated include: (a) cellular assembly and organization, (b) cell signaling and energy metabolism, and (c) immunological, infectious, and inflammatory functions. Furthermore, the analysis identified the category of pathways that facilitate molecular endocytosis and vesicular uptake. Under oligohydramniotic conditions, the mediators of clathrin vesicle-mediated uptake and transport as well as intracellular trafficking mediators were up-regulated. These findings suggest that idiopathic oligohydramnios may be associated with alternations in cellular organization and immunological functions as well as increases in activity of vesicular transport pathways across the amnion.
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Affiliation(s)
- Cecilia Y. Cheung
- Department of Obstetrics and GynecologyCenter for Developmental HealthOregon Health and Sciences UniversityPortlandORUSA
| | - Robert A. Brace
- Department of Obstetrics and GynecologyCenter for Developmental HealthOregon Health and Sciences UniversityPortlandORUSA
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Barbosa RM, Souza RT, Silveira C, Andrade KC, Almeida CM, Bortoleto AG, Oliveira PF, Cecatti JG. Reference ranges for ultrasound measurements of fetal kidneys in a cohort of low-risk pregnant women. Arch Gynecol Obstet 2019; 299:585-591. [PMID: 30607595 DOI: 10.1007/s00404-018-5032-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Alterations in renal dimensions may be an early manifestation of deviation from normality, with possible repercussions beyond intrauterine life. The objective of this study was to establish reference curves for fetal kidney dimensions and volume from 14 to 40 weeks of gestation. METHODS This is a prospective longitudinal study of 115 Brazilian participants in the "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component". Pregnant women with clinical and sociodemographic characteristics allowing the full potential fetal growth were followed up from the first trimester until delivery. These women underwent serial sonographic evaluation of fetal kidneys. The longitudinal, anteroposterior and transverse diameters of both fetal kidneys were measured, in addition to calculation of kidney volume. By quantile regression analysis, reference curves of renal measurements related to gestational age were built. RESULTS Standard normal sonographic values of renal biometry were defined during pregnancy. Reference values for the 10th, 50th and 90th centiles of different fetal kidney measurements (longitudinal, anteroposterior, transverse and volume) from the 14th to the 40th week of gestation were fitted. CONCLUSION The reference curves presented should be of the utmost importance for screening and diagnosis of alterations in renal development during the intrauterine period.
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Affiliation(s)
- Ricardo M Barbosa
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Renato T Souza
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Carla Silveira
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Kleber C Andrade
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Cristiane M Almeida
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Ana G Bortoleto
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Paulo F Oliveira
- Statistics Unit, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil.
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11
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Hesson A, Langen E. Outcomes in oligohydramnios: the role of etiology in predicting pulmonary morbidity/mortality. J Perinat Med 2018; 46:948-950. [PMID: 29924737 DOI: 10.1515/jpm-2017-0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/06/2018] [Indexed: 11/15/2022]
Abstract
Objective Early-onset oligohydramnios is typically secondary to renal-urinary anomalies (RUA) or preterm premature rupture of membranes (PPROM). We compared neonatal pulmonary outcomes between these etiologies. Methods We conducted a retrospective cohort study of women with oligohydramnios identified before 24 completed weeks of gestation attributed to either PPROM or RUA. Patients were excluded if other fetal anomalies were noted. Respiratory morbidity was assessed by the need for oxygen at 36 corrected weeks or at hospital discharge. Results Of 116 eligible patients, 54 chose elective pregnancy termination. A total of 39.5% of PPROM (n=17/43) and 36.8% of RUA (n=7/19) pregnancies experienced pre-viable loss (P=1.00). Significantly fewer PPROM live births resulted in neonatal mortality (26.9% vs. 75.0%, P<0.01). There was no difference in respiratory morbidity (57.9% vs. 66.6%, P=1.00). The collective incidence of respiratory mortality and morbidity was not different between etiologies (P=0.06). Conclusion This analysis suggests that the prognoses for oligohydramnios due to pre-viable PPROM vs. renal anomalies are similarly grave, though RUA infants experienced a higher rate of neonatal respiratory mortality.
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Affiliation(s)
- Ashley Hesson
- University of Michigan Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Elizabeth Langen
- University of Michigan Obstetrics and Gynecology, Ann Arbor, MI, USA
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12
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Beksac MS, Beksac AT, Buyukeren M, Tanacan A, Bektas H, Gucer S. Are Congenital Urinary Tract Abnormalities Linked to Maternal Methylenetetrahydrofolate Reductase Polymorphisms in Fetuses of Intentionally Terminated Pregnancies with Oligo- or Anhydramnios ? Fetal Pediatr Pathol 2018; 37:177-183. [PMID: 29737941 DOI: 10.1080/15513815.2018.1461283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aimed to evaluate fetuses of terminated pregnancies with oligo-or anhydramnios (OAH) to further investigate the association between maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms and fetal urinary tract malformations. MATERIALS AND METHODS This retrospective study included 16 pregnancies with OAH (with normal fetal karyotype) that were intentionally terminated before 22nd gestational week. Fetal autopsy was performed in all cases. We evaluated cases for presence of DNA methylation pathway-related gene polymorphisms. RESULTS We demonstrated that renal abnormalities and disorders exist in 75% of the cases. Pulmonary system anomalies and single umbilical artery were the most frequently observed associated abnormalities. Polymorphisms with known reduced MTHFR activity were found in 81.8% (9/11) of the cases.Association between urinary system abnormalities and polymorphisms with known reduced MTHFR activity was observed in 88.8% (8/9) of the cases. CONCLUSION Physicians should keep in mind that polymorphisms with known reduced MTHFR activity may be associated with urinary tract abnormalities and OAH.
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Affiliation(s)
- M Sinan Beksac
- a Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Alp Tuna Beksac
- b Department of Urology , Hacettepe University , Ankara , Turkey
| | - Melek Buyukeren
- c Division of Neonatology, Department of Pediatrics , Hacettepe University , Ankara , Turkey
| | - Atakan Tanacan
- d Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Hatice Bektas
- e Department of Pediatrics , Hacettepe University , Ankara , Turkey
| | - Safak Gucer
- f Division of Pediatric Pathology, Department of Pediatrics , Hacettepe University , Ankara , Turkey
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13
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Fetal Urinary Tract Anomalies: Review of Pathophysiology, Imaging, and Management. AJR Am J Roentgenol 2018; 210:1010-1021. [DOI: 10.2214/ajr.17.18371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Mehler K, Gottschalk I, Burgmaier K, Volland R, Büscher AK, Feldkötter M, Keller T, Weber LT, Kribs A, Habbig S. Prenatal parental decision-making and postnatal outcome in renal oligohydramnios. Pediatr Nephrol 2018; 33:651-659. [PMID: 29075889 DOI: 10.1007/s00467-017-3812-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/13/2017] [Accepted: 09/11/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period. METHODS We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days. RESULTS After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life. CONCLUSIONS Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.
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Affiliation(s)
- Katrin Mehler
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Kathrin Burgmaier
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Ruth Volland
- Pediatric Oncology and Hematology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Anja K Büscher
- Clinic for Pediatrics II, Pediatric Nephrology, University of Essen, Essen, Germany
| | | | - Titus Keller
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Angela Kribs
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Sandra Habbig
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany.
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15
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Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome. Pediatr Nephrol 2018; 33:541-545. [PMID: 29128922 DOI: 10.1007/s00467-017-3833-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023]
Abstract
The presence of renal oligohydramnios (ROH) in a fetus has been associated in the past with a poor prognosis for survival, although recent studies have shown that survival has improved considerably due to the advances in neonatology and pediatric nephrology. In an article recently published in Pediatric Nephrology, evaluation of a large series by Mehler and colleagues confirms the improved prognosis, showing a survival rate of 32 of 38 (84%). In addition, only 12 of 35 (34%) neonates required renal replacement therapy. In five of these 12 children the dialysis could be terminated after the neonatal period. This study has important implications on the decision-making process and counseling of families. While 37% of families of the study opted for termination of pregnancies, palliative care was chosen by 8% of the families, representing an important option when a decision cannot be made rapidly by affected families. A multidisciplinary approach is not only necessary in the active treatment of neonates with a history of ROH but also in antenatal counseling. In this regard future efforts should establish consensus on an ethical framework for the decision-making process in ROH.
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16
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Thomas AN, McCullough LB, Chervenak FA, Placencia FX. Evidence-based, ethically justified counseling for fetal bilateral renal agenesis. J Perinat Med 2017; 45:585-594. [PMID: 28222038 PMCID: PMC5509412 DOI: 10.1515/jpm-2016-0367] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/28/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Not much data are available on the natural history of bilateral renal agenesis, as the medical community does not typically offer aggressive obstetric or neonatal care asbilateral renal agenesis has been accepted as a lethal condition. AIM To provide an evidence-based, ethically justified approach to counseling pregnant women about the obstetric management of bilateral renal agenesis. STUDY DESIGN A systematic literature search was performed using multiple databases. We deploy an ethical analysis of the results of the literature search on the basis of the professional responsibility model of obstetric ethics. RESULTS Eighteen articles met the inclusion criteria for review. With the exception of a single case study using serial amnioinfusion, there has been no other case of survival following dialysis and transplantation documented. Liveborn babies die during the neonatal period. Counseling pregnant women about management of pregnancies complicated by bilateral renal agenesis should be guided by beneficence-based judgment informed by evidence about outcomes. CONCLUSIONS Based on the ethical analysis of the results from this review, without experimental obstetric intervention, neonatal mortality rates will continue to be 100%. Serial amnioinfusion therefore should not be offered as treatment, but only as approved innovation or research.
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Affiliation(s)
- Alana N. Thomas
- Corresponding author: Alana N. Thomas MD, Baylor college
of Medicine, Texas Children's Hospital, Department of Pediatrics,
Section of Neonatology, 6621 Fannin St, WT-6104, Houston, TX 77030, USA, Tel.:
+ (832) 826-1380, Fax: + (832) 825-1386,
| | - Laurence B. McCullough
- Center for Medical Ethics and Health Policy, Baylor College of
Medicine, Houston, TX, USA; and Department of Obstetrics and Gynecology,
Weill Medical College of Cornell University, New York, NY, USA
| | - Frank A. Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of
Cornell University, New York, NY, USA
| | - Frank X. Placencia
- Department of Pediatrics, Section of Neonatology, Baylor College of
Medicine, Texas Children's Hospital, Houston, TX, USA
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Erger F, Brüchle NO, Gembruch U, Zerres K. Prenatal ultrasound, genotype, and outcome in a large cohort of prenatally affected patients with autosomal-recessive polycystic kidney disease and other hereditary cystic kidney diseases. Arch Gynecol Obstet 2017; 295:897-906. [PMID: 28283827 DOI: 10.1007/s00404-017-4336-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/08/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the sonographic and clinical genotype-phenotype correlations in autosomal recessive polycystic kidney disease (ARPKD) and other cystic kidney diseases (CKD) in a large cohort of prenatally detected fetuses with hereditary CKD. METHODS We retrospectively studied the clinical and diagnostic data of 398 patients referred with prenatal ultrasound findings suggestive of CKD between 1994 and 2010. Cases with confirmed hereditary CKD (n = 130) were analyzed as to their prenatal ultrasound findings, genotype, and possible predictors of clinical outcome. RESULTS ARPKD was most common in our non-representative sample. Truncating PKHD1 mutations led to a significantly reduced neonatal prognosis, with two such mutations being invariably lethal. Sonographically visible kidney cysts occurred in only 3% of ARPKD cases. Renal abnormalities in Meckel syndrome (MKS) appeared earlier than in ADPKD (19.6 ± 3.7 vs. 29.8 ± 5.1 GW) or ARPKD (19.6 ± 3.7 vs. 30.2 ± 1.2 GW). Additional CNS malformations were not found in ARPKD, but were highly sensitive for MKS. Pulmonary hypoplasia, oligo/anhydramnios (OAH), and kidney enlargement were associated with a significantly worse neonatal prognosis. CONCLUSION Genotype, sonographic signs of OAH, enlarged kidney size, and pulmonary hypoplasia can be useful predictors of neonatal survival. We propose sonographic morphological criteria for ARPKD, ADPKD, MKS, and renal cyst and diabetes syndrome (RCAD). We further propose a clinical diagnostic algorithm for differentiating cystic kidney diseases.
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Affiliation(s)
- Florian Erger
- Institute of Human Genetics, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.,Institute of Human Genetics, Cologne University Hospital, Cologne, Germany
| | - Nadina Ortiz Brüchle
- Institute of Human Genetics, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, Bonn University Hospital, Bonn, Germany
| | - Klaus Zerres
- Institute of Human Genetics, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
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18
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Sakai T, Murakami Y, Okuda Y, Hamada R, Hamasaki Y, Ishikura K, Hataya H, Honda M. Prolonged respiratory disorder predicts adverse prognosis in infants with end-stage kidney disease. Pediatr Nephrol 2016; 31:2127-36. [PMID: 27271033 DOI: 10.1007/s00467-016-3430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/27/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous. METHODS Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality. RESULTS Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32). CONCLUSIONS Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.
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Affiliation(s)
- Tomoyuki Sakai
- Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan.
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Okuda
- Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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19
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Lo TK, So CH, Fu YM, Leung YK, Lee H. Renal oligo- and anhydramnios with normal-looking fetal kidneys. Arch Gynecol Obstet 2016; 294:671-2. [PMID: 27435471 DOI: 10.1007/s00404-016-4155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Tsz-Kin Lo
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China.
| | - Chun-Hong So
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - Yu-Ming Fu
- Neonatal Intensive Care Unit, Princess Margaret Hospital, Hong Kong, China
| | - Ying-Kit Leung
- Anatomical Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Hencher Lee
- Chemical Pathology, Princess Margaret Hospital, Hong Kong, China
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20
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Affiliation(s)
- K S Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital and Health Centre of British ColumbiaVancouver, BC, Canada
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21
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Wang PH, Chen CY, Chen CP. Fetal Renal Artery. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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