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Pierucci UM, Paraboschi I, Mantica G, Costanzo S, Riccio A, Selvaggio GGO, Pelizzo G. Antenatal Determinants of Postnatal Renal Function in Fetal Megacystis: A Systematic Review. Diagnostics (Basel) 2024; 14:756. [PMID: 38611669 PMCID: PMC11012172 DOI: 10.3390/diagnostics14070756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: To evaluate the clinical usefulness of demographic data, fetal imaging findings and urinary analytes were used for predicting poor postnatal renal function in children with congenital megacystis. Materials and methods: A systematic review was conducted in MEDLINE's electronic database from inception to December 2023 using various combinations of keywords such as "luto" [All Fields] OR "lower urinary tract obstruction" [All Fields] OR "urethral valves" [All Fields] OR "megacystis" [All Fields] OR "urethral atresia" [All Fields] OR "megalourethra" [All Fields] AND "prenatal ultrasound" [All Fields] OR "maternal ultrasound" [All Fields] OR "ob-stetric ultrasound" [All Fields] OR "anhydramnios" [All Fields] OR "oligohydramnios" [All Fields] OR "renal echogenicity" [All Fields] OR "biomarkers" [All Fields] OR "fetal urine" [All Fields] OR "amniotic fluid" [All Fields] OR "beta2 microglobulin" [All Fields] OR "osmolarity" [All Fields] OR "proteome" [All Fields] AND "outcomes" [All Fields] OR "prognosis" [All Fields] OR "staging" [All Fields] OR "prognostic factors" [All Fields] OR "predictors" [All Fields] OR "renal function" [All Fields] OR "kidney function" [All Fields] OR "renal failure" [All Fields]. Two reviewers independently selected the articles in which the accuracy of prenatal imaging findings and fetal urinary analytes were evaluated to predict postnatal renal function. Results: Out of the 727 articles analyzed, 20 met the selection criteria, including 1049 fetuses. Regarding fetal imaging findings, the predictive value of the amniotic fluid was investigated by 15 articles, the renal appearance by 11, bladder findings by 4, and ureteral dilatation by 2. The postnatal renal function showed a statistically significant relationship with the occurrence of oligo- or anhydramnion in four studies, with an abnormal echogenic/cystic renal cortical appearance in three studies. Single articles proved the statistical prognostic value of the amniotic fluid index, the renal parenchymal area, the apparent diffusion coefficient (ADC) measured on fetal diffusion-weighted MRI, and the lower urinary tract obstruction (LUTO) stage (based on bladder volume at referral and gestational age at the appearance of oligo- or anhydramnios). Regarding the predictive value of fetal urinary analytes, sodium and β2-microglobulin were the two most common urinary analytes investigated (n = 10 articles), followed by calcium (n = 6), chloride (n = 5), urinary osmolarity (n = 4), and total protein (n = 3). Phosphorus, glucose, creatinine, and urea were analyzed by two articles, and ammonium, potassium, N-Acetyl-l3-D-glucosaminidase, and microalbumin were investigated by one article. The majority of the studies (n = 8) failed to prove the prognostic value of fetal urinary analytes. However, two studies showed that a favorable urinary biochemistry profile (made up of sodium < 100 mg/dL; calcium < 8 mg/dL; osmolality < 200 mOsm/L; β2-microglobulin < 4 mg/L; total protein < 20 mg/dL) could predict good postnatal renal outcomes with statistical significance and urinary levels of β2-microglobulin were significantly higher in fetuses that developed an impaired renal function in childhood (10.9 ± 5.0 mg/L vs. 1.3 ± 0.2 mg/L, p-value < 0.05). Conclusions: Several demographic data, fetal imaging parameters, and urinary analytes have been shown to play a role in reliably triaging fetuses with megacystis for the risk of adverse postnatal renal outcomes. We believe that this systematic review can help clinicians for counseling parents on the prognoses of their infants and identifying the selected cases eligible for antenatal intervention.
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Affiliation(s)
- Ugo Maria Pierucci
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | - Irene Paraboschi
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy;
| | - Guglielmo Mantica
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131 Genova, Italy;
| | - Sara Costanzo
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | - Angela Riccio
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | | | - Gloria Pelizzo
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy;
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Sartorius V, Giuseppi A, Iacobelli S, Leroy-Terquem E, Vinit N, Heidet L, Blanc T, Stirnemann J, Kermorvant-Duchemin E, Lapillonne A. Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study. Pediatr Nephrol 2024; 39:505-511. [PMID: 37656311 DOI: 10.1007/s00467-023-06100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV. METHODS Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021. RESULTS Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively). CONCLUSIONS In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, Paris, France.
| | - Agnès Giuseppi
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Silvia Iacobelli
- Department of Neonatal and Pediatric Intensive Care, CHU La Réunion, Saint-Pierre, France
| | - Elise Leroy-Terquem
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Nicolas Vinit
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Laurence Heidet
- Université Paris Cité, Paris, France
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Diseases (MARHEA), AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Julien Stirnemann
- Université Paris Cité, Paris, France
- Department of Obstetrics and Fetal Medicine, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
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Rickard M, Lorenzo AJ, Richter J, Brownrigg N, Kim JK, Chua M, Goraya N, Khondker A, Yadav P, Keefe DT, Shinar S, Dos Santos J. Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes. Pediatr Nephrol 2023; 38:3735-3744. [PMID: 37322171 DOI: 10.1007/s00467-023-06040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND To determine if the implementation of a posterior urethral valves (PUV) clinic and standardized management pathway improves the short-term kidney outcomes of infants with PUV. METHODS From 2016-2022, 50 consecutive patients were divided into groups after the implementation of the clinic (APUV, n = 29) and before (BPUV, n = 21) during a comparable timeframe. Assessed data included age at initial visit, timing and type of surgery, frequency of follow-up visits, medications, nadir creatinine, and development of CKD/kidney failure. Data are shown as median with interquartile range (IQR) and odds ratios (OR) with 95% confidence interval (CI). RESULTS APUV had higher rates of prenatal diagnoses (12/29 vs. 1/21; p = 0.0037), earlier initial surgical intervention (8 days; IQR 0, 105 vs. 33 days; IQR 4, 603; p < 0.0001), and higher rates of primary diversions (10/29 vs. 0/21; p = 0.0028). Standardized management led to earlier initiation of alpha blockers (326 days; IQR 6, 860 vs. 991; IQR 149, 1634; p = 0.0019) and anticholinergics (57 days; IQR 3, 860 vs. 1283 days; IQR 477, 1718; p < 0.0001). Nadir creatinine was reached at earlier ages in APUV (105 days; IQR 2, 303 vs. 164 days; IQR 21, 447; p = 0.0192 BPUV). One patient progressed to CKD5 in APUV compared to CKD3, CKD5 and one transplant in BPUV. CONCLUSION Implementing the PUV clinic with standardized treatment expedited postnatal management and resulted in a higher number of cases detected prenatally, a shift in primary treatment, younger ages at initial treatment, reduced time to nadir creatinine, and timely initiation of supportive medications. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mandy Rickard
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon, Philippines
| | - Noreen Goraya
- Department of Social Work, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Renal Sciences, Lucknow, India
| | - Daniel T Keefe
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Shiri Shinar
- Ontario Fetal Center, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Solinho M, Saraiva S, Lourenço C, Brito C. In Utero Treatment of Obstructive Ureterocele. J Med Ultrasound 2023; 31:154-156. [PMID: 37576425 PMCID: PMC10413404 DOI: 10.4103/jmu.jmu_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 08/15/2023] Open
Abstract
Lower urinary tract obstruction consists of a heterogeneous group of conditions in which the normal urethral egress of urine from the fetal bladder is impaired. The most frequent diagnoses are posterior urethral valves, urethral atresia, and less common obstructive ureterocele. We report a case of a fetus with prenatal diagnosis of obstructive ureterocele who presented progressive bilateral hydronephrosis. A fetal cystoscopy with laser ablation was performed.
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Affiliation(s)
- Mariana Solinho
- Department of Gynecology and Obstetrics, Hospital Distrital de Santarém, E.P.E., Santarém, Portugal
| | - Susana Saraiva
- Department of Gynecology and Obstetrics, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cátia Lourenço
- Center of Prenatal Diagnosis, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Conceição Brito
- Center of Prenatal Diagnosis, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Cassart M. Fetal uropathies: pre- and postnatal imaging, management and follow-up. Pediatr Radiol 2023; 53:610-620. [PMID: 35840694 DOI: 10.1007/s00247-022-05433-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/15/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
Congenital uropathies are the most common fetal anomalies. They include a wide spectrum of anomalies ranging from mild pelvis dilation to complex urinary tract malformations. Prenatal imaging not only allows for their diagnosis but, in experienced hands, it can differentiate obstructive from refluxing or malformative uropathies. Such precise prenatal information allows for intervention before birth in select cases or for adapting the postnatal workup to provide a better long-term outcome. For the different types of congenital uropathies, we describe their prenatal presentations on US and the complementary role of fetal MRI where indicated. We correlate these findings with postnatal workup and summarize the updated neonatal diagnostic and clinical/surgical management.
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Affiliation(s)
- Marie Cassart
- Radiology Department, Iris South Hospitals, Site Elterbeek-Ixelles, 63 Rue Jean Paquot, 1050, Brussels, Belgium.
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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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Richter J, Rickard M, Kim JK, Erdman L, Lorenzo AJ, Chua M. Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Capone V, Persico N, Berrettini A, Decramer S, De Marco EA, De Palma D, Familiari A, Feitz W, Herthelius M, Kazlauskas V, Liebau M, Manzoni G, Maternik M, Mosiello G, Schanstra JP, Vande Walle J, Wühl E, Ylinen E, Zurowska A, Schaefer F, Montini G. Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group. Nat Rev Urol 2022; 19:295-303. [PMID: 35136187 DOI: 10.1038/s41585-022-00563-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Fetal lower urinary tract obstruction (LUTO) is associated with high mortality and postnatal morbidity caused by lung hypoplasia and impaired kidney function. Specific diagnostic features that can guide clinical approach and decisions are lacking; thus, the European Reference Network for Rare Kidney Diseases established a work group to develop recommendations regarding the clinical definition, diagnosis and management of prenatally detected LUTO. The work group recommends the use of antero-posterior diameter of renal pelvis as the most reliable parameter for suspecting obstructive uropathies and for suspecting prenatal LUTO in the presence of fetal megacystis. Regarding prenatal and postnatal prognosis of fetuses with LUTO, the risk of fetal and neonatal death depends on the presence of oligohydramnios or anhydramnios before 20 weeks' gestation, whereas the risk of kidney replacement therapy cannot be reliably foreseen before birth. Parents of fetuses with LUTO must be referred to a tertiary obstetric centre with multidisciplinary expertise in prenatal and postnatal management of obstructive uropathies, and vesico-amniotic shunt placement should be offered in selected instances, as it increases perinatal survival of fetuses with LUTO.
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Affiliation(s)
- Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
| | - Nicola Persico
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Stèphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France.,Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.,Centre De Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Diego De Palma
- Nuclear Medicine Unit, "Circolo" Hospital, ASST-settelaghi, Varese, Italy
| | - Alessandra Familiari
- High Risk Pregnancy Unit, Department of Women, Children and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Wout Feitz
- Department of Urology, Division of Paediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Maria Herthelius
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Vytis Kazlauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Max Liebau
- Department of Pediatrics and Center for Molecular Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Michal Maternik
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Giovanni Mosiello
- Bambino Gesù Pediatric Hospital, Division of Pediatric Urology/Neuro-Urology, Rome, Italy
| | - Joost Peter Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Ghent, Belgium
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.,Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Keil C, Bedei I, Sommer L, Koemhoff M, Axt-Fliedner R, Köhler S, Weber S. Fetal therapy of LUTO (lower urinary tract obstruction) - a follow-up observational study. J Matern Fetal Neonatal Med 2021; 35:8536-8543. [PMID: 34652254 DOI: 10.1080/14767058.2021.1988562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Fetal megacystis (MC) can be severe and is mainly caused by fetal lower urinary tract obstruction (LUTO). Mortality of fetal LUTO can be high as a result of pulmonary hypoplasia and/or (chronic) renal insufficiency. Several technical procedures for vesicoamniotic shunting (VAS) were developed to improve fetal MC outcomes. MATERIAL AND METHODS We present the outcome of nine fetuses with MC who received VAS in the prenatal period (14 + 6 to 27 + 6 weeks GA) using the Somatex® intrauterine shunt system. MC was defined as an increased longitudinal measurement of the bladder >15 mm. The median follow-up time after birth was 18 months. RESULTS Eight Fetuses had uncomplicated VAS intervention. One case developed PPROM 24 h after VAS leading to abortion. Pregnancy was later terminated in further two cases. All six live-born infants received intensive care treatment. Invasive-mechanical ventilation was necessary in one case who died 24 h post-partum of severe cardiac depression. Five infants who survived the follow-up time developed chronic renal insufficiency (CRI), with one infant developing end-stage renal failure requiring peritoneal dialysis. CONCLUSION Overall, 5 of 9 LUTO fetuses (55%) undergoing VAS with the Somatex® intrauterine shunt system showed long-term survival beyond the neonatal period of 28 d (5/9; 55%) with varying morbidity.
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Affiliation(s)
- Corinna Keil
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Giessen, Liebig University Giessen, Giessen, Germany
| | - Lara Sommer
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Martin Koemhoff
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Giessen, Liebig University Giessen, Giessen, Germany
| | - Siegmund Köhler
- Division of Prenatal Medicine and Therapy, Department of Obstetrics and Perinatal Medicine, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Stefanie Weber
- University Children Hospital Marburg, Philipps University Marburg, Marburg, Germany
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Abdelhalim A, Hafez AT. Antenatal and postnatal management of posterior urethral valves: where do we stand? AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Posterior urethral valve (PUV) is the leading etiology of lower urinary tract obstruction (LUTO) in boys and is an important cause of end-stage renal disease (ESRD) in children. The aim of this article is to review the current status on antenatal intervention for PUV as well as postnatal medical and surgical management.
Main body
MEDLINE, EMBASE, Pubmed and Google Scholar search was conducted throughout December 2020 using the keywords: posterior urethral valves, congenital urinary obstruction, antenatal, valve bladder syndrome, medical, anticholinergics, alpha blocker, antibiotics, biofeedback, diversion, augmentation cystoplasty and renal transplantation. Only papers written in English were included. The relevant literature was summarized. Despite advances in antenatal intervention for fetal LUTO, it remains associated with considerable fetal and maternal morbidity. Patient selection criteria for antenatal intervention are greatly debated. Fetal intervention has resulted in improved perinatal survival in properly selected cases, with a questionable benefit to postnatal renal function. There is decent evidence supporting the use of anticholinergics in infants and young children following valve ablation, with less robust evidence advocating alpha blockers, overnight catheter drainage and biofeedback. The role of urinary diversion remains contentious. Optimizing bladder dynamics is crucial for successful renal transplantation outcomes.
Conclusion
While antenatal intervention has failed to improve renal function outcomes of PUV, patient-centered medical and sometimes surgical interventions can help delay the progression of chronic kidney disease. Lifelong monitoring and management of the associated bladder dysfunction is indispensable even after successful renal transplantation.
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Singh N, Bansal V, Satoskar P, Faisal S. A Retrospective Analysis to Evaluate Role of the New UTD Classification System in Prenatal Prediction of Severity and Postnatal Outcome in Antenatally Diagnosed Urinary Tract Dilatation Abnormalities. J Obstet Gynaecol India 2021; 71:268-276. [PMID: 34408346 DOI: 10.1007/s13224-020-01416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background/Purpose of the Study Foetal urinary tract dilation (UTD) abnormalities affect 1-5% of all pregnancies. However, exact incidence is difficult to estimate because of different terminologies used to define the condition and different grading systems to define its severity antenatally as well as postnatally worldwide. In order to overcome this problem, the new UTD classification system has been introduced in the year 2014 so as to have universal approach for diagnosis and management of UTD globally. Indian data about clinical utility of the UTD classification system and its role in prenatal prediction of severity of renal disease are lacking. The present study aims to investigate clinical utility of new UTD classification system in foetal UTD abnormalities and to evaluate the role of UTD classification system in antenatal prediction/prognostication of severity of UTD abnormalities. Methods We conducted a single-centre retrospective study between April 2014 and January 2017, which included 70 infants with antenatally diagnosed UTD delivered in our hospital and managed in our paediatric unit postnatally. Pre- and postnatal ultrasound findings were noted, and UTD-A and UTD-P classification were applied retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcome in all cases was evaluated in terms of need for immediate postnatal urosurgical intervention, presence of persistent UTD pathology and severity of renal impairment in relation to their pre- and postnatal UTD A and P risk categories. Results None from UTD A1 risk group in the last prenatal scan showed significant postnatal UTD abnormality. In contrast to this, UTD A2-3 risk group in the last prenatal scan had persistent postnatal UTD pathology in 70% cases. All infants with abnormal postnatal UTD diagnosis were identified prenatally as UTD A2-3 (high risk). Nine infants (12.8%, n = 70) who needed urosurgical intervention postnatally were categorised as UTD A2-3 prenatally and UTD P3 postnatally. Conclusion We found increased frequency of complications and urosurgical interventions in all infants with antenatal UTD A2-3 grades in the last prenatal scan in comparison with those with UTD A1 grades who showed complete resolution (100%) postnatally. Antenatal UTD classification may be useful in antenatal prediction and prognostication of postnatal severity, especially in high-risk cases (i.e. UTD A2-3).
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Affiliation(s)
- Neha Singh
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Vandana Bansal
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Purnima Satoskar
- Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra India
| | - Shameel Faisal
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra India
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12
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Masselli G, Cozzi D, Ceccanti S, Laghi F, Giancotti A, Brunelli R. Fetal body MRI for fetal and perinatal management. Clin Radiol 2021; 76:708.e1-708.e8. [PMID: 34112509 DOI: 10.1016/j.crad.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound (US) in diagnosing fetal abnormalities. This review is intended to highlight the contribution of MRI in parental counselling and perinatal treatment. A state-of-the-art fetal MRI protocol with experts of maternal-fetal medicine present in the MRI suite allows emphasis on patient-centred care and maximises therapeutic options.
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Affiliation(s)
- G Masselli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - D Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - S Ceccanti
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - F Laghi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Giancotti
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - R Brunelli
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
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Nassr AA, Erfani H, Espinoza J, Sanz Cortes M, Donepudi R, Koh CJ, Roth DR, Braun MC, Angelo JR, Belfort MA, Shamshirsaz AA. Novel scoring system for determining fetal candidacy for prenatal intervention for severe congenital lower urinary tract obstruction. Eur J Obstet Gynecol Reprod Biol 2021; 262:118-123. [PMID: 34010724 DOI: 10.1016/j.ejogrb.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate a novel scoring system that combines several prenatal parameters for selecting ideal candidates for fetal intervention, and for predicting postnatal survival in patients with severe fetal lower urinary tract obstruction (LUTO). METHODS We retrospectively reviewed all cases of severe LUTO evaluated for fetal intervention in a single large fetal center between January 2013 and December 2017. A scoring system for determining fetal candidacy for intervention was retrospectively developed based on postnatal outcomes. The proposed scoring system included fetal urinary biochemistry, renal ultrasound parameters, initial bladder volume, and degree of bladder refill. Relevant demographic characteristics, ultrasound reports and laboratory results were reviewed. Receiver operating characteristic (ROC) curves were used to select the cut-off values for initial bladder volume and degree of bladder refill and to evaluate the performance of the scoring system in predicting postnatal death. RESULTS Of the 79 LUTO patients evaluated, 31 were eligible for the study. The overall 6-month postnatal survival was 64.5 % (20/31). A scoring system (0-8) was suggested with 2 points for unfavorable biochemistry, 4 points for ultrasound evidence of dysplastic kidneys, 1 point for inadequate initial bladder volume and 1 point for inadequate bladder refill. Scores>3 (N = 7) were associated with 0 % 6-month survival. The ROC curve for predicting postnatal mortality showed area under curve (AUC) of 0.82 (95 % CI 0.65-0.99). Subgroup analysis within subjects who underwent fetal intervention (N = 22) also confirmed the significance of the distribution of the scoring system between groups who survived and those who did not after adjustment for GA at delivery (p = 0.01). CONCLUSION We propose a novel scoring system for antenatal evaluation of patients with severe LUTO which may be useful in selecting those candidates most appropriate for intervention and in counseling parents about predicted postnatal outcome.
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Affiliation(s)
- Ahmed A Nassr
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States.
| | - Hadi Erfani
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Jimmy Espinoza
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Magdalena Sanz Cortes
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Roopali Donepudi
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Chester J Koh
- Division of Pediatric Urology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - David R Roth
- Renal Section, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Michael C Braun
- Renal Section, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Michael A Belfort
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Alireza A Shamshirsaz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
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Safdar A, Singh K, Sun RC, Nassr AA. Evaluation and fetal intervention in severe fetal hydronephrosis. Curr Opin Pediatr 2021; 33:220-226. [PMID: 33651757 DOI: 10.1097/mop.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Fetal hydronephrosis secondary to congenital anomalies of the kidney and urinary tract (CAKUT) can adversely affect neonates in the postnatal period with long-term consequences. A prenatal diagnosis of CAKUT can have an early fetal intervention to minimize these consequences. This review aims to provide an overview of the possible fetal intervention with severe hydronephrosis. RECENT FINDINGS Clinical course and outcomes of CAKUT are predicted based on biochemical markers and radiological findings. In spite of advancements and accurately diagnosing the severity of hydronephrosis, there are many controversies surround on selection of cases with antenatal hydronephrosis (ANH) that will benefit from fetal intervention. Despite better diagnosis and techniques fetal intervention is limited to mainly lower urinary tract obstruction patients to improve amniotic fluid volume and assist in lung development. SUMMARY ANH can potentially detect the severity of congenital renal anomalies but unable to recognize a specific disease. A multidisciplinary approach is required to diagnose and properly stage cases of severe CAKUT and potential surgical intervention can be considered.
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Affiliation(s)
- Adnan Safdar
- Renal Section, Texas Children's Hospital, Baylor College of Medicine
| | - Kristianna Singh
- Renal Section, Texas Children's Hospital, Baylor College of Medicine
| | - Raphael C Sun
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
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15
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Selection of candidates for foetal intervention in congenital lower urinary tract obstruction. Curr Opin Obstet Gynecol 2021; 33:123-128. [PMID: 33620890 DOI: 10.1097/gco.0000000000000693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Congenital lower urinary tract obstruction (LUTO) is a rare group of conditions characterized by high perinatal morbidity and mortality if associated with oligohydramnios or anhydramnios in early pregnancy. Although foetal intervention has the potential to improve perinatal survival in a select group of foetuses with LUTO, the actual selection of those candidates most likely to benefit from intervention remains challenging. RECENT FINDINGS Foetuses with LUTO who are potential candidates for prenatal intervention should undergo detailed multidisciplinary evaluation to ensure proper assessment and counselling. Using a combination of multiple ultrasound-based renal parameters, including measurement of foetal bladder volumes before and after vesicocentesis and kidney size and morphology, combined with repeated foetal urine biochemistry may allow for better selection than any single test. SUMMARY Foetal intervention should be offered to women carrying a foetus with LUTO only after appropriate evaluation and counselling. A combined approach utilizing ultrasound and biochemical measurements of foetal renal function appears best. Research focusing on the development of more accurate markers is needed.
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Warring SK, Novoa V, Shazly S, Trinidad MC, Sas DJ, Schiltz B, Prieto M, Terzic A, Ruano R. Serial Amnioinfusion as Regenerative Therapy for Pulmonary Hypoplasia in Fetuses With Intrauterine Renal Failure or Severe Renal Anomalies: Systematic Review and Future Perspectives. Mayo Clin Proc Innov Qual Outcomes 2020; 4:391-409. [PMID: 32793867 PMCID: PMC7411166 DOI: 10.1016/j.mayocpiqo.2020.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to investigate the effect of serial amnioinfusion therapy (SAT) for pulmonary hypoplasia in lower urinary tract obstruction (LUTO) or congenital renal anomalies (CRAs), introduce patient selection criteria, and present a case of SAT in bilateral renal agenesis. We conducted a search of the MEDLINE, EMBASE, Web of Science, and Scopus databases for articles published from database inception to November 10, 2017. Eight studies with 17 patients (7 LUTO, 8 CRA, and 2 LUTO + CRA) were included in the study. The median age of the mothers was 31 years (N=9; interquartile range [IQR], 29-33.5 years), the number of amnioinfusions was 7 (N=17; IQR, 4.5-21), gestational age at first amnioinfusion was 23 weeks and 4 days (N=17; IQR, 21-24.07), gestational age at delivery was 32 weeks and 2 days (N=17; IQR, 30 weeks to 35 weeks and 6.5 days), birthweight of newborns was 3.7 kg (N= 9; IQR, 2.7-3.7 kg), Apgar score at 1 minute was 2.5 (N=8; IQR, 1-6.5), and Apgar score at 5 minutes was 5.5 (N=8; IQR, 0-7.75). In conclusion, SAT may provide fetal pulmonary palliation by reducing the risk of newborn pulmonary compromise secondary to oligohydramnios. Multidisciplinary research efforts are required to further inform treatment and counseling guidelines. We propose a multidisciplinary approach to prenatal classification of fetuses with LUTO to inform patient selection.
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Key Words
- AF, amniotic fluid
- AFI, AF index
- AFV, AF volume
- BRA, bilateral renal agenesis
- CRA, congenital renal anomaly
- DOL, day of life
- GA, gestational age
- IQR, interquartile range
- LUTO, lower urinary tract obstruction
- MVP, maximal vertical pocket
- PD, peritoneal dialysis
- PPROM, preterm premature rupture of membranes
- SAT, serial amnioinfusion therapy
- WHO, World Health Organization
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Affiliation(s)
- Simrit K Warring
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Victoria Novoa
- Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Sherif Shazly
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Mari Charisse Trinidad
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - David J Sas
- Division of Pediatric Nephrology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Brenda Schiltz
- Division of Pediatric Critical Care Medicine, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Mikel Prieto
- Department of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Andre Terzic
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Rodrigo Ruano
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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Klein J, Buffin-Meyer B, Boizard F, Moussaoui N, Lescat O, Breuil B, Fedou C, Feuillet G, Casemayou A, Neau E, Hindryckx A, Decatte L, Levtchenko E, Raaijmakers A, Vayssière C, Goua V, Lucas C, Perrotin F, Cloarec S, Benachi A, Manca-Pellissier MC, Delmas HL, Bessenay L, Le Vaillant C, Allain-Launay E, Gondry J, Boudailliez B, Simon E, Prieur F, Lavocat MP, Saliou AH, De Parscau L, Bidat L, Noel C, Floch C, Bourdat-Michel G, Favre R, Weingertner AS, Oury JF, Baudouin V, Bory JP, Pietrement C, Fiorenza M, Massardier J, Kessler S, Lounis N, Auriol FC, Marcorelles P, Collardeau-Frachon S, Zürbig P, Mischak H, Magalhães P, Batut J, Blader P, Saulnier Blache JS, Bascands JL, Schaefer F, Decramer S, Schanstra JP. Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease. Kidney Int 2020; 99:737-749. [PMID: 32750455 DOI: 10.1016/j.kint.2020.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022]
Abstract
Although a rare disease, bilateral congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage kidney disease in children. Ultrasound-based prenatal prediction of postnatal kidney survival in CAKUT pregnancies is far from accurate. To improve prediction, we conducted a prospective multicenter peptidome analysis of amniotic fluid spanning 140 evaluable fetuses with CAKUT. We identified a signature of 98 endogenous amniotic fluid peptides, mainly composed of fragments from extracellular matrix proteins and from the actin binding protein thymosin-β4. The peptide signature predicted postnatal kidney outcome with an area under the curve of 0.96 in the holdout validation set of patients with CAKUT with definite endpoint data. Additionally, this peptide signature was validated in a geographically independent sub-cohort of 12 patients (area under the curve 1.00) and displayed high specificity in non-CAKUT pregnancies (82 and 94% in 22 healthy fetuses and in 47 fetuses with congenital cytomegalovirus infection respectively). Change in amniotic fluid thymosin-β4 abundance was confirmed with ELISA. Knockout of thymosin-β4 in zebrafish altered proximal and distal tubule pronephros growth suggesting a possible role of thymosin β4 in fetal kidney development. Thus, recognition of the 98-peptide signature in amniotic fluid during diagnostic workup of prenatally detected fetuses with CAKUT can provide a long-sought evidence base for accurate management of the CAKUT disorder that is currently unavailable.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Franck Boizard
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Nabila Moussaoui
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ophélie Lescat
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Decatte
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anke Raaijmakers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christophe Vayssière
- Université Toulouse III Paul-Sabatier, Toulouse, France; Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France; INSERM, UMR1027, Toulouse, France
| | - Valérie Goua
- Prenatal Diagnosis Unit, Poitiers University Hospital, Poitiers, France
| | | | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France; INSERM, U1253, "Imaging and Brain," François-Rabelais University of Tours, Tours, France
| | - Sylvie Cloarec
- Reference Center for Rare Kidney Diseases, Pediatric Nephrology Service, CHRU Clocheville, Tours, France
| | - Alexandra Benachi
- Gynecology-Obstetric Service, AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France
| | - Marie-Christine Manca-Pellissier
- Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Lucie Bessenay
- Pediatric Service, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Emma Allain-Launay
- Pediatric Nephrology Service, Hôpital Mère-Enfants, CHU Nantes, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, Amiens, France; INSERM, U1105, Picardie Jules Verne University, CHU Amiens, Amiens, France
| | | | - Elisabeth Simon
- Prenatal Diagnosis, Fondation Lenval, CHU de Nice, Nice, France
| | - Fabienne Prieur
- Clinical Genetics Service, CHU de Saint-Etienne, Saint-Etienne, France
| | - Marie-Pierre Lavocat
- Department of Pediatrics, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
| | - Anne-Hélène Saliou
- Multidisciplinary Center for Prenatal Diagnosis, CHRU de Brest, Brest, France
| | - Loic De Parscau
- Department of Pediatrics and Medical Genetics, CHRU Morvan, Brest, France
| | - Laurent Bidat
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Catherine Noel
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Corinne Floch
- Pediatric Service, Hôpital Louis Mourier, Colombes, France
| | | | - Romain Favre
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Anne-Sophie Weingertner
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Jean-François Oury
- Gynecology-Obstetrics Service, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Service, Hôpital Universitaire Robert-Debré, APHP, Paris, France
| | - Jean-Paul Bory
- Service de Gynécologie-Obstétrique, Maternité Alix-de-Champagne, CHU de Reims, Reims, France
| | | | - Maryse Fiorenza
- Gynecology-Obstetrics Service, l'Hôpital Mère Enfant de Limoges, Limoges, France
| | - Jérôme Massardier
- Gynecology-Obstetrics Service, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | | | - Nadia Lounis
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Françoise Conte Auriol
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Pascale Marcorelles
- Department of Pathology, EA 4685, Neuronal Epithelium Interaction Laboratory, Université de Bretagne Occidentale Brest, France
| | - Sophie Collardeau-Frachon
- Department of Pathology, Children and Mother's Hospital, Groupement Hospitalier Est, CHU de Lyon-Bron, France
| | - Petra Zürbig
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pedro Magalhães
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Julie Batut
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Patrick Blader
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Jean-Sebastien Saulnier Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Pediatric Nephrology Service, Hôpital des Enfants, CHU Toulouse, Toulouse, France; Reference Center for Rare Renal Diseases of the Southwest (SORARE), Toulouse, France.
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
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18
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Current State of Fetal Intervention for Obstructive Uropathy–Focus on Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00600-5] [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]
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19
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Katsoufis CP. Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction. Pediatr Nephrol 2020; 35:1193-1201. [PMID: 31197474 DOI: 10.1007/s00467-019-04280-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
Congenital lower urinary tract obstruction is associated with oligohydramnios and significant perinatal mortality and long-term chronic kidney disease. The counseling of families facing this diagnosis, especially when prenatal intervention is proposed, is fraught with ambiguity. This review aims to equip the provider with the current evidence behind the conventional and novel biomarkers predictive of chronic kidney disease. The relevant clinical predictors are categorized by when they are identified, antenatally or postnatally, and as either anatomic or chemical. They are considered for their prognostic value and the challenges in obtaining them, specifically the risk to the fetus in the case of prenatal biomarkers. Serum creatinine in infancy is the traditional chemical biomarker of kidney function and continues to be a consistent predictor of future serum creatinine. β-2 microglobulin may provide earlier information regarding fetal glomerular and tubular function and is also predictive of long-term serum creatinine. Renal parenchymal area is an anatomic surrogate of nephron mass that is used in both prenatal and postnatal settings. Understanding the anatomic and chemical biomarkers is essential for future refinement of the staging algorithm used to distinguish which patients may benefit from early in utero intervention.
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Affiliation(s)
- Chryso Pefkaros Katsoufis
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine/Holtz Children's Hospital, P.O. Box 016960 (M-714), Miami, FL, 33101, USA.
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20
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Abstract
Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.
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Affiliation(s)
- Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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21
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Pavlaki A, Begou O, Deda O, Farmaki E, Dotis J, Gika H, Taparkou A, Raikos N, Papachristou F, Theodoridis G, Printza N. Serum-Targeted HILIC-MS Metabolomics-Based Analysis in Infants with Ureteropelvic Junction Obstruction. J Proteome Res 2020; 19:2294-2303. [PMID: 32351114 DOI: 10.1021/acs.jproteome.9b00855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) constitutes the predominant cause of obstructive nephropathy in both neonates and infants. Fundamental questions regarding UPJO's mechanism, assessment, and treatment still remain unanswered. The aim of the present study was to elucidate potential differences through serum metabolic profiling of surgical cases of infants with UPJO compared to both nonsurgical cases and healthy age-matched controls. Early diagnosis of renal dysfunction in this cohort based on highlighted biomarkers was the ultimate goal. Thus, serum samples were collected from 20 patients preoperatively, 19 patients with mild stenosis treated conservatively, and 17 healthy controls. All samples were subjected to targeted metabolomics analysis by hydrophilic interaction liquid chromatography coupled to mass spectrometry (HILIC LC-MS/MS). Both univariate and multivariate statistical analyses were performed. Principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) score plots showed that the studied groups differed significantly, with a panel of metabolites, including creatinine, tryptophan, choline, and aspartate, distinguishing patients who required surgery from those followed by systematical monitoring as well as from healthy controls, showing high performance as indicators of UPJO disease.
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Affiliation(s)
- Antigoni Pavlaki
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Olga Begou
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.,Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, Thermi 57001, Greece
| | - Olga Deda
- Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, Thermi 57001, Greece.,Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Evangelia Farmaki
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - John Dotis
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Helen Gika
- Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, Thermi 57001, Greece.,Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Anna Taparkou
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Nikolaos Raikos
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Fotios Papachristou
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Georgios Theodoridis
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.,Biomic_Auth, Bioanalysis and Omics Lab, Centre for Interdisciplinary Research of Aristotle University of Thessaloniki, Innovation Area of Thessaloniki, Thermi 57001, Greece
| | - Nikoleta Printza
- Paediatric Nephrology Unit, First Department of Paediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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22
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Buffin-Meyer B, Tkaczyk M, Stańczyk M, Breuil B, Siwy J, Szaflik K, Talar T, Wojtera J, Krzeszowski W, Decramer S, Klein J, Schanstra JP. A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves. Pediatr Nephrol 2020; 35:469-475. [PMID: 31701236 DOI: 10.1007/s00467-019-04390-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Posterior urethral valves (PUVs) account for 17% of pediatric renal failure. The management of pregnancies involving fetuses with PUV is hampered by the fact that current clinical parameters obtained from fetal ultrasound and/or fetal urine biochemistry are insufficient to predict postnatal renal function. We previously have developed a fetal urine peptide signature (12PUV) that predicted with high precision postnatal renal failure at 2 years of age in fetuses with PUV. Here, we evaluated the accuracy of this signature to predict postnatal renal outcome in fetuses with PUV in an independent single-center study. METHODS Thirty-three women carrying fetuses with suspected PUV were included. Twenty-five fetuses received vesicoamniotic shunts during pregnancy. PUV was confirmed postnatally in 23 patients. Of those 23 fetuses, 2 were lost in follow-up. Four and 3 patients died in the pre- and perinatal periods, respectively. Follow-up renal function at 6 months of age was obtained for the remaining 14 patients. The primary outcome was early renal failure, defined by an eGFR < 60 mL/min/1.73 m2 before 6 months of age or pre- or perinatal death. RESULTS The peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 (95%CI 0.74-1.0) and an accuracy of 90% (95%CI 78-100). The signature predicted postnatal renal outcome for the suspected PUV cases with an AUC of 0.89 (95%CI 0.72-0.97) and an accuracy of 84% (95%CI 71-97). CONCLUSIONS This single-center study confirms the predictive power of the previously identified 12PUV fetal urinary peptide signature.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Krzysztof Szaflik
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Justyna Wojtera
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Waldemar Krzeszowski
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
- Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
- Centre de Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.
- Université Toulouse III Paul-Sabatier, Toulouse, France.
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23
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Beksac MS, Beksac AT, Tanacan A, Mumusoglu S, Katlan D, Celik HT. Antenatal hydronephrosis and fetal urine sampling. Congenit Anom (Kyoto) 2020; 60:4-9. [PMID: 30629771 DOI: 10.1111/cga.12324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study is to evaluate the significance of renal pelvis aspiration (RPA) in the management of antenatal hydronephrosis (AHN). This study enrolled 15 AHN cases (one twin pregnancy) that necessitated RPA for AHN. Chromosomal abnormalities, gene disorders, and additional life-threatening congenital abnormalities were eliminated prior to intrauterine interventions. Urine analysis were performed for the evaluation of renal function. Normal renal function was observed in six neonates/infants (40%) (group 1), whereas impaired renal function and various type of urinary system anomalies were observed in 9 neonates/infants (60%) (group 2) during the short-term and longitudinal follow-up periods. There were statistically significant differences in the oligohydroamniosis rate, mean fetal urine sodium value, mean fetal urine β2-microglobulin, mean gestational week at birth, and mean birthweight values between the groups (P = 0.007, P < 0.001, P = 0.035, P < 0.001, and P = 0.001, respectively). Renal pelvis aspiration and urine analysis were substantial for the management of AHN in necessary cases. β2-microglobulin and sodium are clinically useful markers to detect the presence of severe renal damage due to obstructive uropathy and thus, important adjuvants in the proper selection of fetuses for further antenatal interventions.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Sezcan Mumusoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Katlan
- Department of Obstetrics and Gynecology, Süleymaniye Research and Training Hospital, Istanbul, Turkey
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24
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Perlman S, Borovitz Y, Ben-Meir D, Hazan Y, Nagar R, Bardin R, Brusilov M, Dekel B, Achiron R, Gilboa Y. Prenatal diagnosis and postnatal outcome of anterior urethral anomalies. Prenat Diagn 2019; 40:191-196. [PMID: 31654578 DOI: 10.1002/pd.5582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/24/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Anterior urethral anomalies (AUA) which present as anterior urethral valve, stenosis or atresia, are a rare cause for congenital urinary tract obstruction. We present our AUA prenatal diagnosis case series. METHODS Fetuses presenting with prenatal findings suggestive for AUA according to postnatal reported clinical and imaging signs (urinary tract dilatation, dilated bladder, enlarged edematous fetal penis, dilatation of the fetal urethra and diverticula) were followed prospectively. RESULTS Six fetuses were diagnosed with AUA. Diagnosis was confirmed upon examination of the neonate or the abortus. All cases presented with variable degrees of urinary tract dilatation. Four fetuses who presented with additional congenital anomalies of the kidneys and urinary tract (CAKUT) developed intra-uterine or early postnatal renal failure, while two isolated AUA cases have a normal renal outcome. CONCLUSIONS AUA is a rare diagnosis. However, high index of suspicion and careful sonographic assessment of the male fetal urethra in cases referred for urinary tract dilatation may enable appropriate parent counseling, optimal prenatal surveillance and timed postnatal urological intervention. As in other lower urinary tract obstructions, future renal function seems to correlate with associated CAKUT, therefore close follow up throughout pregnancy and meticulous sonographic assessment is recommended.
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Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Borovitz
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Schneider Children's Medical Center, Nephrology Institute, Petach Tikva, Israel
| | - David Ben-Meir
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Urology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Yenon Hazan
- Ultrasound Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.,Hadassah and the Hebrew University Medical School, Jerusalem, Israel
| | - Ran Nagar
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Bardin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Michael Brusilov
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Dekel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Pediatric Nephrology, Edmond and Lily Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Pediatric Stem Cell Research Institute, Edmond and Lily Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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25
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Duin LK, Fontanella F, Groen H, Adama van Scheltema PN, Cohen-Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Oepkes D, Bilardo CM. Prediction model of postnatal renal function in fetuses with lower urinary tract obstruction (LUTO)-Development and internal validation. Prenat Diagn 2019; 39:1235-1241. [PMID: 31659787 DOI: 10.1002/pd.5573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop a prediction model of postnatal renal function in fetuses with lower urinary tract obstruction (LUTO) based on fetal ultrasound parameters and amniotic fluid volume. METHODS Retrospective nationwide cohort study of fetuses with postnatally confirmed LUTO and known eGFR. Fetuses treated with fetal interventions such as vesico-amniotic shunting or cystoscopy were excluded. Logistic regression analysis was used to identify prognostic ultrasound variables with respect to renal outcome following multiple imputation of missing data. On the basis of these fetal renal parameters and amniotic fluid volume, a model was developed to predict postnatal renal function in fetuses with LUTO. The main study outcome was an eGFR less than 60 mL/min * 1.73 m2 based on the creatinine nadir during the first year following diagnosis. Model performance was evaluated by receiver operator characteristic (ROC) curve analysis, calibration plots, and bootstrapping. RESULTS Hundred one fetuses with a confirmed diagnosis of LUTO were included, eGFR less than 60 was observed in 40 (39.6%) of them. Variables predicting an eGFR less than 60 mL/min * 1.73m2 included the following sonographic parameters: hyperechogenicity of the renal cortex and abnormal amniotic fluid volume. The model showed fair discrimination, with an area under the ROC curve of 0.70 (95% confidence interval, 0.59-0.81, 0.66 after bootstrapping) and was overall well-calibrated. CONCLUSION This study shows that a prediction model incorporating ultrasound parameters such as cortical appearance and abnormal amniotic fluid volume can fairly discriminate an eGFR above or below 60 mL/min * 1.73m2 . This clinical information can be used in identifying fetuses eligible for prenatal interventions and improve counseling of parents.
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Affiliation(s)
- Leonie K Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands
| | - Federica Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Phebe N Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Mireille Bekker
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christine Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, VU University Medical Center, Amsterdam, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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26
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Nassr AA, Shamshirsaz AA, Erfani H, Espinoza J, Sanz Cortes M, Koh CJ, Roth DR, Angelo JR, Mandy GT, Braun MC, Ruano R, Belfort MA. Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in second trimester of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:500-505. [PMID: 30977189 DOI: 10.1002/uog.20288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Congenital lower urinary tract obstruction (LUTO) is a rare condition with high perinatal mortality and morbidity when associated with severe oligohydramnios or anhydramnios in the second trimester of pregnancy. Severe pulmonary hypoplasia and end-stage renal disease are the underlying causes of poor neonatal outcome in these cases. However, little is known about the subset of fetal LUTO that is associated with a normal volume of amniotic fluid at midgestation. The objective of the current study was to describe the natural history, underlying causes, survival and postnatal renal function outcomes in pregnancies with fetal LUTO and normal amniotic fluid volume during the second trimester of pregnancy. METHODS This was a retrospective study of all pregnancies with fetal LUTO and normal amniotic fluid volume in the second trimester that received prenatal and postnatal care at our quaternary care institution between 2013 and 2017. Data on demographic characteristics, fetal interventions, perinatal survival, need for neonatal respiratory support, postnatal renal function and need for dialysis at the age of 1 and 24 months were analyzed. RESULTS Of the 18 fetuses that met the study criteria, 17 (94.4%) survived the perinatal period. Eleven (61.1%) pregnancies developed oligohydramnios in the third trimester, six of which were eligible for and underwent fetal intervention with vesicoamniotic shunt placement, which was performed successfully in all six cases. Two (11.1%) neonates required respiratory support owing to pulmonary hypoplasia. At the age of 2 years, 14 children had follow-up information available, two (14.3%) of whom had normal renal function, eight (57.1%) had developed some degree of chronic kidney disease (Stage 1-4) and four (28.6%) had developed end-stage renal disease (ESRD), including two who had already manifested ESRD in the neonatal period. CONCLUSIONS Most fetuses diagnosed prenatally with LUTO that is associated with a normal volume of amniotic fluid at midgestation will have a favorable outcome in terms of perinatal survival and few will need long-term respiratory support. However, these children are still at increased risk for chronic renal disease, ESRD and need for renal replacement therapy. Larger multicenter studies are needed to characterize the prenatal factors associated with postnatal renal function, and to investigate the role of fetal intervention in the group of fetuses that present with late-onset oligohydramnios and evidence of preserved fetal renal function. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - H Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - C J Koh
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - D R Roth
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J R Angelo
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - G T Mandy
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M C Braun
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - R Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
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27
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Buffin-Meyer B, Klein J, van der Zanden LFM, Levtchenko E, Moulos P, Lounis N, Conte-Auriol F, Hindryckx A, Wühl E, Persico N, Oepkes D, Schreuder MF, Tkaczyk M, Ariceta G, Fossum M, Parvex P, Feitz W, Olsen H, Montini G, Decramer S, Schanstra JP. The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design. Clin Kidney J 2019; 13:371-379. [PMID: 32699617 PMCID: PMC7367108 DOI: 10.1093/ckj/sfz107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease.
A major issue in the management of PUV is prenatal prediction of postnatal renal
function. Fetal ultrasound and fetal urine biochemistry are currently employed for this
prediction, but clearly lack precision. We previously developed a fetal urine peptide
signature that predicted in utero with high precision postnatal renal
function in fetuses with PUV. We describe here the objectives and design of the
prospective international multicentre ANTENATAL (multicentre validation of a fetal urine
peptidome-based classifier to predict postnatal renal function in posterior urethral
valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until
2023 in >30 European centres endorsed and supported by European reference networks
for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The
endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05,
1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400
patients need to be enrolled to validate the previously reported sensitivity and
specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a
novel tool to the clinic. Based on urinary peptides and potentially amended in the
future with additional omics traits, this tool will be able to precisely quantify
postnatal renal survival in PUV pregnancies. The main limitation of the employed
approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management
of fetuses with PUV.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Levtchenko
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | | | - Nadia Lounis
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Françoise Conte-Auriol
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Sergio Bonelli Centre for the Prevention of Renal Failure from Fetal to Pediatric Age, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dick Oepkes
- Department of Prenatal Diagnosis and Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Gema Ariceta
- Servei de Nefrologia Pediátrica Hospital, Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Magdalena Fossum
- Section of Pediatric Urology, Department of Highly Specialized Pediatric Surgery and Pediatric Medicine, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Paloma Parvex
- Pediatric Nephrology, Unité Romande de Néphrologie Pédiatrique, Hôpitaux Universitaire Genève (HUG), Genève, Switzerland
| | - Wout Feitz
- For ERN eUROGEN, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henning Olsen
- For ERN eUROGEN, Paediatric Urology, Department of Urology, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Giovanni Montini
- For ERN ERKNet, Pediatric Nephrology-Centro Sergio Bonelli for the Prevention and Treatment of Urinary Tract Malformations, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France.,Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.,Centre De Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
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Cheung KW, Morris RK, Kilby MD. Congenital urinary tract obstruction. Best Pract Res Clin Obstet Gynaecol 2019; 58:78-92. [PMID: 30819578 DOI: 10.1016/j.bpobgyn.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/01/2019] [Accepted: 01/07/2019] [Indexed: 12/14/2022]
Abstract
Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China; The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.
| | - Rachel Katie Morris
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; The Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark David Kilby
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; The Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
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29
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Chiodini B, Ghassemi M, Khelif K, Ismaili K. Clinical Outcome of Children With Antenatally Diagnosed Hydronephrosis. Front Pediatr 2019; 7:103. [PMID: 30984723 PMCID: PMC6449796 DOI: 10.3389/fped.2019.00103] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 01/29/2023] Open
Abstract
Fetal renal pelvis dilation is a common condition, which is observed in 1-4. 5% of pregnancies. In many cases, this finding resolves spontaneously. However, sometimes it may be a signal of significant urinary tract pathologies. The main abnormalities found after birth are uretero-pelvic junction stenosis, primary vesicoureteral reflux, megaureter, duplex kidneys, and posterior urethral valves, with uretero-pelvic junction stenosis and primary vesicoureteral reflux accounting for most of the cases. Diagnosis, management, and prognosis at short and longer term of these conditions will be reviewed in this article.
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Affiliation(s)
- Benedetta Chiodini
- Department of Pediatric Nephrology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Mehran Ghassemi
- Department of Medical Imaging, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Karim Khelif
- Department of Pediatric Urology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Khalid Ismaili
- Department of Pediatric Nephrology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
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30
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Dreux S, Rosenblatt J, Moussy-Durandy A, Patin F, Favre R, Lortat-Jacob S, El Ghoneimi A, Oury JF, Deschenes G, Ville Y, Heidet L, Muller F. Urine biochemistry to predict long-term outcomes in fetuses with posterior urethral valves. Prenat Diagn 2018; 38:964-970. [PMID: 30207389 DOI: 10.1002/pd.5359] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Because the literature on the predictive value of fetal urinalysis is controversial in fetuses with lower urinary tract obstruction, we determined the best model of fetal urine biochemical markers correlated with long-term postnatal renal function based on glomerular filtration rate (GFR). METHOD This retrospective study concerned 89 fetuses with lower urinary tract obstruction and their renal function after 10 years of age. We correlated fetal urine biochemical markers (total protein, β2-microglobulin, sodium, chloride, glucose, calcium, and phosphorus) with GFR at 10 to 30 years of age in 89 patients with posterior urethral valves. We defined five stages of chronic kidney disease (CKD). RESULTS Of the 89 patients, 18 (20%) are 20 years old or over. Postnatal renal function was good in 67.4% (GFR > 60 mL/min/1.73 m2 ) and poor in 17% (GFR < 30 mL/min/1.73 m2 ). All fetal urine markers differed between CKD stage 1 + 2 and CKD stage 4 + 5 (P < 0.001). β2-microblobulin showed an 87% sensitivity for a 72% specificity. A combination of β2-microglobulin and chloride gave the best results (93% sensitivity and 71% specificity) versus amniotic fluid volume (80% sensitivity and 73% specificity). CONCLUSION Fetal urine biochemistry predicts long-term (10-30 years) postnatal renal function.
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Affiliation(s)
- Sophie Dreux
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | | | - Amélie Moussy-Durandy
- Pediatric Nephrology, and Reference Center for Hereditary Renal Diseases (MARHEA), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Franck Patin
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Romain Favre
- Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | | | - Alaa El Ghoneimi
- Pediatric Surgery, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Jean-François Oury
- Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Georges Deschenes
- Pediatric Nephrology, Robert Debré Hospital, AP-HP, Paris, France.,University Paris Diderot, Paris, France
| | - Yves Ville
- Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Paris, France
| | - Laurence Heidet
- Pediatric Nephrology, and Reference Center for Hereditary Renal Diseases (MARHEA), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Francoise Muller
- Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
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31
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Gatzweiler E, Hoppe B, Dewald O, Berg C, Müller A, Reutter H, Kipfmueller F. Extracorporeal membrane oxygenation support in a newborn with lower urinary tract obstruction and pulmonary hypoplasia: a case report. J Med Case Rep 2018; 12:210. [PMID: 30012211 PMCID: PMC6048767 DOI: 10.1186/s13256-018-1749-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
Background Survival of neonates with intrauterine renal insufficiency and oligo- or anhydramnios correlates with the severity of secondary pulmonary hypoplasia. Early prenatal diagnosis together with repetitive amnioinfusions and modern intensive care treatment have improved the prognosis of these neonates. Extracorporeal membrane oxygenation is an established treatment option, mainly applied to neonates with pulmonary hypoplasia caused by congenital diaphragmatic hernia. However, a few case reports of extracorporeal membrane oxygenation in neonates with lower urinary tract obstruction have been published. Case presentation We describe a case of a Caucasian male infant with prenatally diagnosed lower urinary tract obstruction and secondary pulmonary hypoplasia who was delivered spontaneously at 36 + 2 weeks of gestation. Venovenous extracorporeal membrane oxygenation was initiated on the first day of life for severe respiratory failure and consecutive hypoxemia despite treatment with inhaled nitric oxide and high-frequency oscillation. The patient was supported by extracorporeal membrane oxygenation for 10 days and extubated 6 weeks later. Hemofiltration was required on the second day of life because of renal insufficiency and was later replaced by peritoneal dialysis. The child was discharged after 4 months with nasal high-flow mild oxygen therapy and peritoneal dialysis. Conclusion Neonatal extracorporeal membrane oxygenation support is a possible treatment option for neonates with lower urinary tract obstruction and pulmonary hypoplasia.
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Affiliation(s)
- Eva Gatzweiler
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
| | - Bernd Hoppe
- Department of Pediatric Nephrology, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Christoph Berg
- Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
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32
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Buffin-Meyer B, Klein J, Breuil B, Muller F, Moulos P, Groussolles M, Bouali O, Bascands JL, Decramer S, Schanstra JP. Combination of the fetal urinary metabolome and peptidome for the prediction of postnatal renal outcome in fetuses with PUV. J Proteomics 2018; 184:1-9. [PMID: 29929039 DOI: 10.1016/j.jprot.2018.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 01/15/2023]
Abstract
Most of biomarker panels, extracted from single omics traits, still need improvement since they display a gray zone where prediction is uncertain. Here we verified whether a combination of omics traits, fetal urinary metabolites and peptides analyzed in the same sample, improved prediction of postnatal renal function in fetuses with posterior urethral valves (PUV) compared to individual omics traits. Using CE-MS, we explored the urinary metabolome of 13 PUV fetuses with end stage renal disease (ESRD) and 12 PUV fetuses without postnatal ESRD at 2 years postnatally. This allowed the selection of 24 differentially abundant metabolite features which were modelled into predictive classifiers, alone or in combination with 12 peptides previously identified as predictive of ESRD. Validation in 35 new fetuses showed that the combination of peptides and metabolites significantly outperformed the 24 metabolite features with increased AUC (0.987 vs 0.905), net reclassification improvement (36%) and better sensitivity accuracy (86% vs 60%). In addition, the two trait combination tended to improve, but without reaching statistical significance, the already high performances of the 12 peptide biomarkers (AUC 0.967, accuracy 80%). In conclusion, this study demonstrates the potential of cumulating different omics traits in biomarker research where single omics traits fall short. SIGNIFICANCE Although increasingly proposed in disease-diagnosis and -prognosis because of their improved efficacy over single markers, panels of body fluid biomarkers based on single omics analysis still fail to display perfect accuracy, probably due to biological variability. Here, we hypothesized that combination of different omics traits allowed to better capture this biological variability. As proof of concept, we studied the added value of fetal urine metabolites and peptides using CE-MS, starting from the same urine sample, to predict postnatal renal outcome in fetuses with posterior urethral valves. We observed that the prognostic power of combined metabolite and peptide markers was clearly higher than that of metabolites alone and slightly, but non-significantly, improved compared to the peptides alone. To our knowledge, this report is the first to demonstrate that combining multiomics traits extracted from (fetal) urine samples displays clear promise for kidney disease stratification.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Françoise Muller
- CHU Paris, Hôpital Robert Debré, Laboratoire de Biochimie-Hormonologie, Paris, France
| | | | - Marion Groussolles
- CHU Toulouse, Hôpital Paule de Viguier, Service d'Echographie et Diagnostic prénatal, Toulouse, France; INSERM, U1027, Toulouse, France
| | - Ourdia Bouali
- CHU Toulouse, Hôpital des Enfants, Service de Chirurgie viscérale, Toulouse, France
| | - Jean-Loup Bascands
- INSERM, U1188, Sainte Clotilde/La Réunion, France; Université de La Réunion, Sainte Clotilde/La Réunion, France
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France; CHU Toulouse, Hôpital des Enfants, Service de Néphrologie - Médecine Interne - Hypertension Pédiatrique, Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
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33
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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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34
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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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35
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Practical Management of Fetal Obstructive Uropathy. JOURNAL OF FETAL MEDICINE 2018. [DOI: 10.1007/s40556-017-0147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Abstract
PURPOSE OF THE REVIEW In this article, we explore the origins of intervention of fetal lower urinary tract obstruction, and we specifically discuss the background and recent outcomes of vesicoamniotic shunt placement and fetal cystoscopy. The article seeks to provide a comprehensive overview of the field while bringing the reader quickly up to speed on the pertinent literature and the critical data that are available to guide decision-making regarding intervention. RECENT FINDINGS Appropriate patient selection for fetal intervention remains challenging despite advances in prenatal imaging. Both a randomized controlled trial and multiple systematic reviews show evidence of a perinatal survival benefit following fetal intervention but rates of renal morbidity remain very high. Despite 30 years of research, fetal lower urinary tract obstruction remains a difficulty entity to treat. Intervention may lead to survival, but physicians and caregivers must remain alert for the distinct possibility of long-term renal morbidity in survivors.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children's Way, 4102 Doctor's Office Tower, Nashville, TN, 37232, USA.
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children's Way, 4102 Doctor's Office Tower, Nashville, TN, 37232, USA
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37
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Werner H, Lopes J, Ribeiro G, Jésus NR, Santos GR, Alexandria HAF, Ruano R, Araujo Júnior E. Three-dimensional virtual cystoscopy: Noninvasive approach for the assessment of urinary tract in fetuses with lower urinary tract obstruction. Prenat Diagn 2017; 37:1350-1352. [DOI: 10.1002/pd.5188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/29/2017] [Accepted: 11/09/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Heron Werner
- Department of Radiology; Clínica de Diagnóstico por Imagem (CPDI); Rio de Janeiro RJ Brazil
| | - Jorge Lopes
- Department of Design; Pontifícia Universidade Católica (PUC-Rio); Rio de Janeiro RJ Brazil
| | - Gerson Ribeiro
- Department of Design; Pontifícia Universidade Católica (PUC-Rio); Rio de Janeiro RJ Brazil
| | - Nilson Ramires Jésus
- Department of Obstetrics and Gynecology; State University of Rio de Janeiro (UERJ); Rio de Janeiro RJ Brazil
| | - Gildasio Rocha Santos
- Department of Obstetrics and Gynecology; State University of Rio de Janeiro (UERJ); Rio de Janeiro RJ Brazil
| | | | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center; Mayo Clinic College of Medicine; Rochester MN USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
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Hindryckx A, Raaijmakers A, Levtchenko E, Allegaert K, De Catte L. Analysis of renal blood flow and renal volume in normal fetuses and in fetuses with a solitary functioning kidney. Prenat Diagn 2017; 37:1213-1218. [PMID: 29023893 DOI: 10.1002/pd.5167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/25/2017] [Accepted: 10/03/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate renal blood flow and renal volume for the prediction of postnatal renal function in fetuses with solitary functioning kidney (SFK). METHODS Seventy-four SFK fetuses (unilateral renal agenesis [12], multicystic dysplastic kidney [36], and severe renal dysplasia [26]) were compared with 58 healthy fetuses. Peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the renal artery (RA) were measured; 2D and 3D (VOCAL) volumes were calculated. Renal length and glomerular filtration rate (GFR) were obtained in SFK children (2 years). RESULTS Compared with the control group, the PSV RA was significantly lower in nonfunctioning kidneys and significantly higher in SFK. Volume measurements indicated a significantly larger volume of SFK compared with healthy kidneys. All but 4 children had GFR above 70 mL/min/1.73 m2 , and compensatory hypertrophy was present in 69% at 2 years. PSV RA and SFK volume correlated with postnatal renal hypertrophy. No correlation between prenatal and postnatal SFK volume and GFR at 2 years was demonstrated. CONCLUSION Low PSV RA might have a predictive value for diagnosing a nonfunctioning kidney in fetuses with a SFK. We demonstrated a higher PSV RA and larger renal volume in the SFK compared with healthy kidneys.
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Affiliation(s)
- An Hindryckx
- Department of Obstetrics and Gynecology, KU Leuven, Belgium
| | | | | | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Belgium.,Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luc De Catte
- Department of Obstetrics and Gynecology, KU Leuven, Belgium
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Clinical investigation of chromosomal karyotype analysis in cells cultured from fetal bladder puncture liquid. Exp Ther Med 2017; 14:1879-1883. [PMID: 28962098 PMCID: PMC5609194 DOI: 10.3892/etm.2017.4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/21/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the feasibility of performing chromosomal karyotype analysis using cells cultured from fetal bladder puncture liquid (FBPL). Therefore, FBPL was extracted from 9 fetuses under ultrasonographic guidance, including 3 cases with fetal lower urinary tract obstruction (megabladder and oligohydramnios) and 6 cases with multiple malformations. The cells obtained from the FBPL were cultured in vitro for chromosome preparation and karyotype analysis. The cells from these 9 cases were all successfully cultured, and the chromosomal mitotic phases obtained could be used for counting and karyotype analysis. The gestational age ranged from 14 weeks and 2 days to 22 weeks, the amount of FBPL extracted was 30-55 ml, and the cell culture time ranged from 14 to 21 days. Eight cases in which the cells were subcultured exhibited 22-30 chromosomal mitotic phases, whereas 1 case without subculture showed 11 chromosomal mitotic phases. Cells obtained from the FBPL were successfully used for karyotype analysis following in vitro culture, thus demonstrating that prenatal fetal chromosome examination is possible in patients with a low gestational age, megabladder and oligohydramnios. These observations indicate that this technique has the potential to be used as a new prenatal diagnostic method.
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40
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Ruano R, Dunn T, Braun MC, Angelo JR, Safdar A. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr Nephrol 2017; 32:1871-1878. [PMID: 28730376 DOI: 10.1007/s00467-017-3593-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 11/25/2022]
Abstract
The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18 weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30 weeks; prenatal surveillance is recommended. Stage II LUTO is characterized by oligohydramnios/anhydramnios, hyperechogenic kidneys but absent renal cortical cysts or apparent signs of renal dysplasia and favorable fetal urinary biochemistry; fetal vesicoamniotic shunting (VAS) or fetal cystoscopy is indicated to prevent pulmonary hypoplasia and renal failure. Stage III LUTO is oligohydramnios/anhydramnios, hyperechogenic kidneys with cortical cysts and renal dysplasia and unfavorable fetal urinary biochemistry after serial evaluation; fetal vesicoamniotic shunt may prevent severe pulmonary hypoplasia but not renal failure. Stage IV is characterized by intrauterine fetal renal failure, defined by anhydramnios and ultrasound (US) findings suggestive of severe renal dysplasia, and is associated with death in 24 h of life or end-stage renal disease (ESRD) within the first week of life; fetal vesicoamniotic shunt and fetal cystoscopy are not indicated.
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Affiliation(s)
- Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Timothy Dunn
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Michael C Braun
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Adnan Safdar
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
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Harper L, Waubant A, Vignes J, Amat S, Dobremez E, Lefevre Y, Ferdynus C. Can quantity of amniotic fluid reliably predict postnatal renal function in boys with posterior urethral valves: a decision curve analysis. Prenat Diagn 2017; 37:931-934. [PMID: 28753736 DOI: 10.1002/pd.5120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/29/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prenatal management of male fetuses with suspected posterior urethral valves depends on reliable markers for postnatal long-term renal function. Whether ultrasound parameters, including the presence or absence of oligohydramnios, are reliable remains the subject of debate. We decided to evaluate the reliability of quantity of amniotic fluid to predict postnatal renal function using decision curve analysis (DCA), a method for evaluating the clinical utility of a diagnostic test. METHODS We analyzed retrospectively 51 male fetuses born with prenatally suspected posterior urethral valves between 2009 and 2012. We studied the relationship between quantity of amniotic fluid on prenatal ultrasound and the nadir creatinine during the first year of life as a proxy of postnatal renal function using DCA. RESULTS Twelve fetuses presented with prenatal oligohydramnios. Thirty-one children had a normal nadir creatinine, of which one had prenatal oligohydramnios (3.2%). Thirteen had a nadir creatinine between 35 and 75 μmol/L, of which four had prenatal oligohydramnios (30.8%). Seven had a nadir creatinine >75 μmol/L, all of them had prenatal oligohydramnios. CONCLUSION In this retrospective study, DCA confirms the relationship between prenatal quantity of amniotic fluid volume and postnatal renal function. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luke Harper
- Department of Pediatric Surgery, CHU de La Réunion, Saint-Denis, La Reunion, France.,Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - Alice Waubant
- Department of Pediatric Surgery, CHU de La Réunion, Saint-Denis, La Reunion, France
| | - Julien Vignes
- Department of Pediatric Surgery, CHU de La Réunion, Saint-Denis, La Reunion, France
| | - Sara Amat
- Prenatal Diagnosis, Maternity, MSP Bagatelle, Talence, France
| | - Eric Dobremez
- Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - Yan Lefevre
- Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, La Reunion, France.,INSERM, CIC 1410, Saint Pierre, La Reunion, France
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Nassr AA, Shazly SAM, Abdelmagied AM, Araujo Júnior E, Tonni G, Kilby MD, Ruano R. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:696-703. [PMID: 27270578 DOI: 10.1002/uog.15988] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect on perinatal and postnatal survival of vesicoamniotic shunt (VAS) as treatment for fetal lower urinary tract obstruction (LUTO). METHODS An electronic search of Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus using relevant search terms was conducted from inception to June 2015 to identify studies comparing outcomes of VAS vs conservative management for treatment of LUTO. Cohort studies and clinical trials were considered eligible. Single-arm studies and studies that did not report survival were excluded. Sample size and language were not criteria for exclusion. Two reviewers extracted independently data in a standardized form, including study characteristics and results. Primary outcomes were perinatal and postnatal survival. Secondary outcome was postnatal renal function. Data on fetal survival were expressed as odds ratio (OR) and 95% CI. RESULTS Of the 423 abstracts retrieved, nine studies were eligible for inclusion. These studies included 112 fetuses treated with VAS and 134 that were managed conservatively. There was heterogeneity in study design. Although the data demonstrated a difference in effect estimates between the study arms in terms of perinatal survival (OR, 2.54 (95% CI, 1.14-5.67)), there was no difference in 6-12-month survival (OR, 1.77 (95% CI, 0.25-12.71)) or 2-year survival (OR, 1.81 (95% CI, 0.09-38.03)). In addition, there was no difference in effect on postnatal renal function between fetuses that underwent intervention and those that did not (OR, 2.09 (95% CI, 0.74-5.94)). CONCLUSIONS Available data seem to support an advantage for perinatal survival in fetuses treated with VAS compared with conservative management. However, 1-2-year survival and outcome of renal function after VAS procedure remain uncertain. Further studies are necessary to evaluate the effectiveness of fetal intervention for LUTO based on different severity of the disease, due to the very low quality of the studies according to GRADE guidelines. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - S A M Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - A M Abdelmagied
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| | - G Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - M D Kilby
- Centre for Women's and Children's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Ruano
- Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic, Rochester, MN, USA
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Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann JJ, Guimiot F, Heidet L, Favre R, Salomon LJ, Oury JF, Ville Y, Muller F. Sequential fetal serum β2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:617-622. [PMID: 27197901 DOI: 10.1002/uog.15968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome. METHODS We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome. RESULTS Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant). CONCLUSION Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - G Faure
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - I Czerkiewicz
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - J J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Guimiot
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, Paris, France
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | - L J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - J F Oury
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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Nassr AA, Koh CK, Shamshirsaz AA, Espinoza J, Sangi-Haghpeykar H, Sharhan D, Welty S, Angelo J, Roth D, Belfort MA, Braun M, Ruano R. Are ultrasound renal aspects associated with urinary biochemistry in fetuses with lower urinary tract obstruction? Prenat Diagn 2016; 36:1206-1210. [DOI: 10.1002/pd.4958] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/20/2016] [Accepted: 10/31/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Ahmed A. Nassr
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
- Department of Obstetrics and Gynecology, Women's Health Hospital; Assiut University; Asiut Egypt
| | - Chester Koh Koh
- Division of Pediatric Urology; Texas Children's Hospital Pavilion for Women; Houston TX USA
| | - Alireza A. Shamshirsaz
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Dina Sharhan
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Stephen Welty
- Department of Pediatrics; Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women; Houston TX USA
| | - Joseph Angelo
- Renal Section; Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital; Houston TX USA
| | - David Roth
- Division of Pediatric Urology; Texas Children's Hospital Pavilion for Women; Houston TX USA
| | - Michael A. Belfort
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Fetal Center; Houston TX USA
| | - Michael Braun
- Renal Section; Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital; Houston TX USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology; Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine; Rochester MN USA
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Pardo Vargas RA, Aracena M, Aravena T, Cares C, Cortés F, Faundes V, Mellado C, Passalacqua C, Sanz P, Castillo Taucher S. [Congenital anomalies of poor prognosis. Genetics Consensus Committee]. ACTA ACUST UNITED AC 2016; 87:422-431. [PMID: 27234469 DOI: 10.1016/j.rchipe.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Genetic Branch of the Chilean Society of Paediatrics, given the draft Law governing the decriminalisation of abortion on three grounds, focusing on the second ground, which considers the "embryo or foetus suffering from a congenital structural anomaly or a genetic disorder incompatible with life outside the womb", met to discuss the scientific evidence according to which congenital anomalies (CA) may be included in this draft law. METHODOLOGY Experts in clinical genetics focused on 10 CA, reviewed the literature evidence, and met to discuss it. RESULTS It was agreed not to use the term "incompatible with life outside the womb", as there are exceptions and longer survivals, and change to "congenital anomaly of poor prognosis (CAPP)". Ten CA were evaluated: serious defects of neural tube closure: anencephaly, iniencephaly and craniorachischisis, pulmonary hypoplasia, acardiac foetus, ectopia cordis, non-mosaic triploidy, "limb body wall" complex, "body stalk" anomaly, trisomy 13, trisomy 18, and bilateral renal agenesis. Findings on the prevalence, natural history, prenatal diagnostic methods, survival, and reported cases of prolonged survival were analysed. Post-natal survival, existence of treatments, and outcomes, as well as natural history without intervention, were taken into account in classifying a CA as a CAPP. CONCLUSION A CAPP would be: anencephaly, severe pulmonary hypoplasia, acardiac foetus, cervical ectopia cordis, non-mosaic triploidy, limb body wall complex, body stalk anomaly, non-mosaic trisomy 13, non-mosaic trisomy 18, and bilateral renal agenesis. For their diagnosis, it is required that all pregnant women have access to assessments by foetal anatomy ultrasound and occasionally MRI, and cytogenetic and molecular testing.
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Affiliation(s)
- Rosa A Pardo Vargas
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile.
| | - Mariana Aracena
- Unidad de Genética, Hospital Luis Calvo Mackenna, Santiago, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Teresa Aravena
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Indisa, Santiago, Chile
| | - Carolina Cares
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Dávila, Santiago, Chile
| | - Fanny Cortés
- Centro de Enfermedades Raras, Clínica Las Condes, Santiago, Chile
| | - Víctor Faundes
- Laboratorio de Genética y Enfermedades Metabólicas, INTA, Universidad de Chile, Santiago, Chile
| | - Cecilia Mellado
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricia Sanz
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Sección Genética, Hospital San Juan de Dios, Santiago, Chile
| | - Silvia Castillo Taucher
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Clínica Alemana, Santiago, Chile
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Farrugia MK. Fetal bladder outlet obstruction: Embryopathology, in utero intervention and outcome. J Pediatr Urol 2016; 12:296-303. [PMID: 27570093 DOI: 10.1016/j.jpurol.2016.05.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022]
Abstract
Fetal bladder outlet obstruction (BOO), most commonly caused by posterior urethral valves (PUV), remains a challenging and multi-faceted condition. Evolving techniques, and refinement in ultrasound, optics and instrumentation, have increased our rate of prenatal diagnosis, and enabled valve ablation not only in smaller newborns, but also in fetuses. Long-term outcome studies have raised our awareness of the silent damage caused by bladder dysfunction and polyuria and encouraged their proactive management. In spite of our best efforts, the proportion of boys with PUV who progress to chronic and end-stage renal disease (ESRD) has not changed in the last 25 years. Evidence suggests a reduction in perinatal mortality following prenatal intervention, probably resulting from amelioration of oligohydramnios at the crucial time of lung development between 16 and 28 weeks' gestation, but no improvement in postnatal renal outcome. There are no bladder functional outcome studies in patients who have undergone prenatal intervention and hence the long-term effect of in utero defunctionalisation of the bladder is not known. This aim of this review is to revisit the embryopathology of fetal BOO, in particular the renal and bladder structural and functional changes that occur with in utero obstruction. The effect of earlier prenatal diagnosis, and therapy, on postnatal outcome is also explored and compared with outcomes published for traditional postnatal treatment.
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Affiliation(s)
- Marie-Klaire Farrugia
- Chelsea Children's Hospital at the Chelsea & Westminster Hospital Foundation Trust, London SW10 9NH, UK.
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47
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Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Safdar A, Moaddab A, Meyer N, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Braun MC, Belfort MA. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:476-482. [PMID: 26690832 DOI: 10.1002/uog.15844] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported. RESULTS Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival. CONCLUSIONS Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. ,
| | - N Sananes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - C Wilson
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - J Au
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - C J Koh
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - P Gargollo
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A Safdar
- Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - N Meyer
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - D L Cass
- Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - O O Olutoye
- Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - O A Olutoye
- Department of Anesthesiology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - S Welty
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - D R Roth
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - M C Braun
- Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
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Prognostic factors and biomarkers of congenital obstructive nephropathy. Pediatr Nephrol 2016; 31:1411-20. [PMID: 26667236 DOI: 10.1007/s00467-015-3291-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
Congenital obstructive nephropathy (CON) is the leading cause of chronic kidney disease (CKD) in children. Anomalies of the urinary tract are often associated with abnormal nephrogenesis, which is compounded by obstructive injury and by maternal risk factors associated with low birth weight. Currently available fetal and postnatal imaging and analytes of amniotic fluid, urine, or blood lack predictive value. For ureteropelvic junction obstruction, biomarkers are needed for optimal timing of pyeloplasty; for posterior urethral valves, biomarkers of long-term prognosis and CKD are needed. The initial nephron number may be a major determinant of progression of CKD, and most patients with CON who progress to renal failure reach this point in adulthood, presumably compounded by episodes of acute kidney injury. Biomarkers of tubular injury may be of particular value in predicting the need for surgical intervention or in tracking progression of CKD, and must be adjusted for patient age. Discovery of new biomarkers may depend on "unbiased" proteomics, whereby patterns of urinary peptide fragments from patients with CON are analyzed in comparison to controls. Most promising are the analysis of urinary exosomes (restricting biomarkers to relevant tubular cells) and quantitative magnetic resonance imaging techniques allowing precise determination of nephron number and tubular mass. The greatest need is for large prospective multicenter studies with centralized biomarker sample repositories to follow patients with CON from fetal life through adulthood.
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Chitrit Y, Bourdon M, Korb D, Grapin-Dagorno C, Joinau-Zoulovits F, Vuillard E, Paye-Jaouen A, Peycelon M, Belarbi N, Delezoide AL, Schmitz T, El Ghoneimi A, Sibony O, Oury JF. Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses? Prenat Diagn 2016; 36:831-7. [DOI: 10.1002/pd.4868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Yvon Chitrit
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Mathilde Bourdon
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Diane Korb
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | | | | | - Edith Vuillard
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Matthieu Peycelon
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Nadia Belarbi
- Department of Pediatric Imaging; Hôpital Robert Debré AP-HP; Paris France
| | - Anne-Lyse Delezoide
- Department of Developmental Biology; Hôpital Robert Debré AP-HP; Paris France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Alaa El Ghoneimi
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
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50
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Intrauterine vesicoamniotic shunting for fetal megacystis. Arch Gynecol Obstet 2016; 294:1175-1182. [PMID: 27394921 DOI: 10.1007/s00404-016-4152-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the outcome of fetuses with megacystis treated with vesicoamniotic shunting (VAS) from 14 weeks onward. METHODS Retrospective review of all fetuses that received VAS at two centres from 2004 to 2012. RESULTS 53 fetuses with megacystis were included in the study. Mean gestational age at diagnosis was 16.4 weeks. Mean gestational age at first shunt placement was 17.8 weeks. The first shunt placement was performed before 16 weeks in 18 (34 %) cases. The mean number of shunts was 1.38. Dislocation occurred in 35 (66 %). TOP was performed in 21 (39.6 %), intrauterine death occurred in two (3.8 %) and spontaneous abortion in three cases (5.7 %). Of the 27 (50.9 %) live births, 17 (32.1 %) infants survived. Normal renal function was present in 10 cases, 4 have compensated renal failure and 3 infants had renal transplantation. Oligohydramnios was significantly associated with non-survival and renal insufficiency. The gestational age at VAS was neither correlated with renal function after birth nor with the survival in our cohort. Conversely, the interval between first shunt placement and delivery was positively correlated with survival and normal renal function. The gestational age at delivery was significantly higher in survivors and those born with normal renal function. CONCLUSION Despite intervention, the morbidity and mortality of megacystis is still high. We failed to demonstrate that early intervention is associated with an improved rate of normal renal function after birth. Oligohydramnios was the only parameter identifying fetuses with unfavourable outcome, while all other parameters were inconclusive.
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