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Ogawa T, Takizawa F, Mukoyama Y, Ogawa A, Ito J. Renal morphology and function from childhood to adulthood in Turner syndrome. Clin Exp Nephrol 2021; 25:633-640. [PMID: 33616778 DOI: 10.1007/s10157-021-02031-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/30/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Turner syndrome (TS) is a chromosomal disorder with various complications, including congenital anomaly of the kidney and urinary tract (CAKUT). However, its renal function remains poorly known. Therefore, this study aimed to evaluate renal function in TS of various ages from childhood to adulthood. METHODS We retrospectively analyzed 63 patients with TS who visited our hospital between 1989 and 2020, examined their renal morphology, and analyzed renal function by calculating the estimated glomerular filtration rate (eGFR) using formulas applicable for Japanese populations. RESULTS Renal morphological abnormality was observed in 22 cases (35.0%) (horseshoe kidney, 7 [11.1%]; hydronephrosis, 11 [17.5%]; duplex collecting system, 3 [4.8%]; and single unilateral kidney, 1 [1.6%]). We evaluated the eGFR of 47 subjects aged 2.8-39.3 years and classified them into Group 1 (with CAKUT, n = 15) and Group 2 (without CAKUT, n = 32). The eGFR at the first visit and the final follow-up was not statistically different between these groups. In Group 1 with CAKUT, the eGFR was not significantly different between that at the first visit and that at the final follow-up (p = 0.21). During the observation period (median, 7.9 years), the eGFR of all individuals in both groups gradually decreased with age, but did not fall < 60 mL/min/1.73 m2, which defines chronic kidney disease (CKD). CONCLUSIONS The renal function of TS remained normal in all cases during our investigation period, and no one developed CKD by the age of 40 years.
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Affiliation(s)
- Tetsushi Ogawa
- Department of Pediatrics, Toranomon hospital, 2-2-2 Tranomon, Minato-ku, Tokyo, 1058470, Japan.
| | - Fumihiko Takizawa
- Department of Pediatrics, Toranomon hospital, 2-2-2 Tranomon, Minato-ku, Tokyo, 1058470, Japan
| | - Yuri Mukoyama
- Department of Pediatrics, Toranomon hospital, 2-2-2 Tranomon, Minato-ku, Tokyo, 1058470, Japan
| | - Atsushi Ogawa
- Department of Pediatrics, Toranomon hospital, 2-2-2 Tranomon, Minato-ku, Tokyo, 1058470, Japan
| | - Junko Ito
- Department of Pediatrics, Toranomon hospital, 2-2-2 Tranomon, Minato-ku, Tokyo, 1058470, Japan
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Izumita Y, Nishigaki S, Satoh M, Takubo N, Numakura C, Takahashi I, Soneda S, Abe Y, Kamasaki H, Ohtsu Y, Igaki J, Hasegawa Y, Nagasaki K. Retrospective study of the renal function using estimated glomerular filtration rate and congenital anomalies of the kidney-urinary tract in pediatric Turner syndrome. Congenit Anom (Kyoto) 2020; 60:175-179. [PMID: 32638418 DOI: 10.1111/cga.12384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/14/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
Although Turner syndrome (TS) is frequently associated with congenital anomalies of the kidney-urinary tract (CAKUT), which is a major cause of pediatric chronic kidney disease, renal function in TS is usually considered normal. The present study aimed to analyze the frequency of renal dysfunction and CAKUT in pediatric patients with TS. Our study included 122 patients with TS between the ages of 2 and 18 years from 30 hospitals across Japan. Clinical data related to renal function and CAKUT were retrospectively collected. The estimated glomerular filtration rate (eGFR) was calculated using the serum creatinine-based formula recommended by the Japanese Society for Pediatric Nephrology. An eGFR <90 mL/min/1.73 m2 for two consecutive years was defined as renal dysfunction. Fifteen (13.5%) of 122 patients had CAKUT, and four patients had renal dysfunction (3.2%, 95% confidence interval: 0%-6.7%). Three of the four did not have CAKUT. Of the CAKUT manifestations, horseshoe kidney, renal hypodysplasia, and multicystic dysplastic kidney were seen in nine, two, and one patient, respectively. Eight of the nine patients with horseshoe kidney had a normal renal function; however, the remaining patient with renal hypodysplasia had renal dysfunction. A small percentage of patients with pediatric TS may had an eGFR below 90 mL/min/1.73 m2 which was not necessarily associated with CAKUT.
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Affiliation(s)
- Yukie Izumita
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Satsuki Nishigaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mari Satoh
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Noriyuki Takubo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chikahiko Numakura
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
| | - Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Shun Soneda
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshifusa Abe
- Children Medical Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hotaka Kamasaki
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiaki Ohtsu
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junko Igaki
- Department of Pediatric Endocrinology and Metabolism, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Gao Z, Wang Z, Liu J, Niu B, Yang W, Wang Y, Liang H, Li Y, Li H, He X. Evaluation of Renal Function in Children with Congenital Scoliosis and Congenital Anomalies of the Kidney and Urinary Tract. Med Sci Monit 2018; 24:4667-4678. [PMID: 29979645 PMCID: PMC6069507 DOI: 10.12659/msm.908839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to compare renal function in children with congenital scoliosis and congenital anomalies of the kidney and urinary tract, with healthy children. Material/Methods Biochemical tests were performed before surgery (pre-therapy) and after surgery (post-therapy) in 16 children with congenital scoliosis and congenital anomalies of the kidney and urinary tract. Thirty-two healthy children were matched for age, sex, and weight (healthy controls). General renal function tests included serum electrolytes, creatinine, urea, cystatin C, and estimated glomerular filtration rate (eGFR). Tests for early renal changes included N-acetyl-beta-D-glucosaminidase (NAG), urine microalbumin, serum transferrin, immunoglobulin G (IgG), urinary alpha-1-microglobulin (A1M), and beta-2-microglobulin (B2M). Results Sixteen patients with congenital anomalies of the kidney and urinary tract included eight boys (mean age, 11.38±2.00 years) and eight girls (mean age, 11.00±2.78 years). There were no significant differences in renal function between the pre-therapy and post-therapy groups (P>0.05), or between the three groups (pre-therapy, post-therapy, and healthy controls). In the pre-therapy group, there were significant differences in IgG, A1M, NAG, and serum phosphate levels between boys and girls, urine microalbumin was significantly increased in girls, but not boys (P<0.05). There were no significant differences between the pre-therapy group and post-therapy group (P>0.05). Conclusions Routine tests of renal function were normal in children with congenital scoliosis and congenital anomalies of the kidney and urinary tract, but early changes in renal function occurred before surgical treatment, indicating long-term follow-up of renal function is recommended.
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Affiliation(s)
- Zhengchao Gao
- Department of Othopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Zhengmou Wang
- Department of Nephrology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jiantao Liu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Binbin Niu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Wenlong Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yibin Wang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hui Liang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yuhuan Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xijing He
- Department of Orthopaedics , Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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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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Kanzaki G, Tsuboi N, Haruhara K, Koike K, Ogura M, Shimizu A, Yokoo T. Factors associated with a vicious cycle involving a low nephron number, hypertension and chronic kidney disease. Hypertens Res 2015; 38:633-41. [PMID: 26084263 DOI: 10.1038/hr.2015.67] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 12/15/2022]
Abstract
It has been reported that there is substantial variation in the nephron number between individuals. Previous studies using autopsy kidneys have demonstrated that a low nephron number, in relation to a low birth weight, may result in hypertension (HTN) and/or chronic kidney disease (CKD). However, recent studies have revealed that the association between a low nephron number and HTN is not a universal finding. This observation indicates that a low nephron number is unlikely to be the sole factor contributing to an elevated blood pressure. In addition to the nephron number, various genetic and congenital factors may contribute to increased susceptibility to HTN and/or CKD in a complex manner. Acquired factors, including aging, obesity and related metabolic abnormalities, and various causes of renal injury, may additionally promote further nephron loss. Such a vicious cycle may induce HTN and/or CKD via the common mechanisms of renal hemodynamic maladaptation.
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Affiliation(s)
- Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Ogura
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Luyckx VA, Bertram JF, Brenner BM, Fall C, Hoy WE, Ozanne SE, Vikse BE. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet 2013; 382:273-83. [PMID: 23727166 DOI: 10.1016/s0140-6736(13)60311-6] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Developmental programming of non-communicable diseases is now an established paradigm. With respect to hypertension and chronic kidney disease, adverse events experienced in utero can affect development of the fetal kidney and reduce final nephron number. Low birthweight and prematurity are the most consistent clinical surrogates for a low nephron number and are associated with increased risk of hypertension, proteinuria, and kidney disease in later life. Rapid weight gain in childhood or adolescence further compounds these risks. Low birthweight, prematurity, and rapid childhood weight gain should alert clinicians to an individual's lifelong risk of hypertension and kidney disease, prompting education to minimise additional risk factors and ensuring follow-up. Birthweight and prematurity are affected substantially by maternal nutrition and health during pregnancy. Optimisation of maternal health and early childhood nutrition could, therefore, attenuate this programming cycle and reduce the global burden of hypertension and kidney disease in the future.
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Affiliation(s)
- Valerie A Luyckx
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
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Brotherton J, Pedroso J. Pelvic kidney in a BRCA-1-positive patient undergoing prophylactic bilateral salpingo-oophorectomy. J Minim Invasive Gynecol 2013; 20:547-8. [PMID: 23562106 DOI: 10.1016/j.jmig.2013.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 01/22/2013] [Accepted: 01/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Joy Brotherton
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California.
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Renal function and injury in infants and young children with congenital heart disease. Pediatr Nephrol 2013; 28:99-104. [PMID: 22923204 DOI: 10.1007/s00467-012-2292-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/28/2012] [Accepted: 07/31/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate renal function and injury in infants and young children with congenital heart disease (CHD). METHODS We prospectively enrolled 58 CHD children aged ≤3 years and 20 age-matched controls and divided these into four groups: Group I, acyanotic CHD (n = 24); Group II, cyanotic CHD with arterial oxygen saturation of >75 % (n = 20); Group III, cyanotic CHD with arterial oxygen saturation of ≤75 % (n = 14); Group IV, normal controls (n = 20). Urinary levels of microalbumin (MA), N-acetyl-ß-D-glucosaminidase (NAG), and α1-microglobulin (α1-MG) corrected by creatinine (UCr) were compared. RESULTS Children with CHD had elevated urinary α1-MG/UCr levels, with Group III children having the highest level. Groups I and III children had higher urinary NAG/UCr levels than those of Groups II and IV. Urinary MA/UCr levels in the three patient groups were comparable and significantly higher than that in the control group. A α1-MG × 100/ (α1-MG + MA) of <15 %, indicative of glomerular damage, was present in two patients in Group I and one in Group III, but none in Group II. CONCLUSIONS Tubular injury can occur in CHD patients during infancy and early childhood. Among our patient cohort, it was most prominent in children with severe cyanosis. Glomerular injury was detected in some individuals with advanced heart failure or severe cyanosis.
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Fogelgren B, Kuroyama MC, McBratney-Owen B, Spence AA, Melahn LE, Anawati MK, Cabatbat C, Alarcon VB, Marikawa Y, Lozanoff S. Misexpression of Six2 is associated with heritable frontonasal dysplasia and renal hypoplasia in 3H1 Br mice. Dev Dyn 2008; 237:1767-79. [PMID: 18570229 PMCID: PMC2955765 DOI: 10.1002/dvdy.21587] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A radiation-induced mouse mutant, Brachyrrhine (Br), exhibits frontonasal dysplasia and renal hypoplasia, two malformations associated with deficiencies in mesenchymal condensation. The purpose of this study was to resolve the Br locus, evaluate possible candidate genes, and identify developmental defects in the mutant chondrocranium. Linkage analysis mapped the Br mutation to a critical region distal to D17Mit76, which contains only one gene, the transcription factor Six2. Sequence analysis of the Six2 gene, including 1.5 kb of the promoter, failed to reveal the Br mutation. However, homozygous Br/Br embryos showed almost complete absence of Six2 mRNA and protein in craniofacial and renal tissues while heterozygous Br/+ embryos displayed intermediate Six2 levels. Mutant embryos displayed malformations of neural crest-derived structures of the anterior cranium where Six2 is normally expressed. These data suggest a mutation in a novel cis-acting regulatory region inhibits Six2 expression and is associated with frontonasal dysplasia and renal hypoplasia.
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Affiliation(s)
- Ben Fogelgren
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Mari C. Kuroyama
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | | | - Allyson A. Spence
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Laura E. Melahn
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Mireille K. Anawati
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Chantelle Cabatbat
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Vernadeth B. Alarcon
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Yusuke Marikawa
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
| | - Scott Lozanoff
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i School of Medicine, Honolulu, HI 98613
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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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