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Shi T, Lao W, Ouyang K, Chen Y, Zhang Y, Luo J, Chen S. Laparoscopic pyeloplasty for newborns with severe hydronephrosis. Front Pediatr 2024; 12:1343211. [PMID: 38560400 PMCID: PMC10979644 DOI: 10.3389/fped.2024.1343211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Aim We aimed to investigate the short-term efficacy and safety of laparoscopic pyeloplasty for treating newborns with severe hydronephrosis due to ureteropelvic junction obstruction (UPJO). Methods A retrospective analysis was performed on 16 newborn patients with severe neonatal hydronephrosis who underwent laparoscopic pyeloplasty at our hospital from January 2021 to November 2022. All patients were regularly followed up. Laparoscopic pyeloplasty with double J stent placement was performed after the presence of severe hydronephrosis was confirmed. Results Among the 16 pediatric patients (13 males, 3 females), the left side was affected in 13 cases and the right side in 3. The average age at surgery was 9.50 (8.50-12.00) days, with an average weight of 3.30 ± 0.95 kg. Laparoscopic pyeloplasty was performed in all cases without the need for open conversion. The mean surgery duration was 292.06 ± 73.60 min, with minimal blood loss (2.50, 2.00-5.00 ml). Postoperative hospital stays averaged 13.44 ± 4.70 days. No anastomotic leakage occurred, and follow-ups at 1, 3, 6, and 12 months showed no stent displacement, except for one case where the stent was removed at 1 month, and the others at 3 months. There were no cases of worsened hydronephrosis, except for one with renal atrophy at the 6-month follow-up. Changes in renal pelvis anteroposterior diameter exhibited a time effect (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Notably, differences were observed between 6 and 3 months, as well as between 12 and 3 months postoperatively (P < 0.05). Similarly, renal parenchymal thickness changes showed a time effect Pediatric urology, Guangdong Women and Children Hospital, Guangzhou, China (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Significant differences were also noted between 6 and 1 month, as well as between 12 and 1 month postoperatively (P < 0.05). There was one case of urinary tract infection after surgery, and no case of recurrence was observed. Conclusion Severe neonatal hydronephrosis must be treated promptly. Laparoscopic pyeloplasty is a safe and feasible treatment with minimal complications for newborn patients with severe hydronephrosis due to UPJO.
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Affiliation(s)
| | - Weihua Lao
- Pediatric Urology, Guangdong Women and Children Hospital, Guangzhou, China
| | | | - Yueqing Chen
- Pediatric Urology, Guangdong Women and Children Hospital, Guangzhou, China
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Jeffery M, Tai-MacArthur S, Shangaris P, Duggan M, Spencer J, Sankaran S. Trends in Termination of Pregnancy for Foetal Urological Abnormalities in England and Wales: a Cross-Sectional Study. Reprod Sci 2023; 30:1350-1358. [PMID: 36175615 PMCID: PMC10159963 DOI: 10.1007/s43032-022-01094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
The detection of developmental abnormalities in the foetus is considered an essential component of antenatal screening. Among the most frequently identified sonographically, and possibly one of the easiest recognised, are those affecting the urinary tract, with an incidence of 1-4 in 1000 pregnancies. As such, foetal urological abnormalities represent up to 30% of all prenatally diagnosed congenital anomalies. We analysed information recorded on the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC) for 2015 to 2019. There were 915 cases of termination of pregnancy for foetal urological anomaly between 2015 and 2019 in England and Wales, representing 0.09% of total abortions. There has been a steady increase in cases, from 186 in 2015 to 222 in 2018, followed by a more recent decline in 2019 to 172. All 915 cases were justified under Ground E of The Abortion Act 1967. Most terminations of pregnancy for foetal urological anomaly were carried out at 20 weeks gestation. Isolated urinary tract single diagnoses were the commonest, with megacystis being the most prevalent, followed by bilateral renal agenesis and bilateral cystic kidneys. Nearly a third of cases (32.2%) were performed in women aged 30-34 years, and almost 4/5 of women (78.7%) were of White ethnicity. Foetal urological abnormality is a complex issue affecting a significant minority of pregnant women. When severe abnormalities are detected by prenatal diagnosis, most women choose to terminate the pregnancy.
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Affiliation(s)
- Megan Jeffery
- GKT School of Biomedical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Sarah Tai-MacArthur
- School of Bioscience Education, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Panicos Shangaris
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine King's College London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK.
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | | | - Srividhya Sankaran
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health and Social Care, London, UK
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Liu L, Li J, Li Y, Li H, Yang B, Fan H, Wang J, Gu Y, Yu H, Bai M, Yu T, Cui S, Cheng G, Ren C. Genetic diagnosis of common fetal renal abnormalities detected on prenatal ultrasound. Prenat Diagn 2022; 42:894-900. [PMID: 35478332 DOI: 10.1002/pd.6154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This retrospective study aimed to investigate the correlations between phenotypes of fetal renal abnormalities on prenatal ultrasound and genetic aetiologies detected using chromosomal microarray analysis (CMA) and whole-exome sequencing (WES). METHODS Fetuses with renal abnormalities were subjected to CMA and were further analysed by WES when CMA-negative. The detection rates for chromosomal abnormalities and monogenic variants among different types of isolated renal abnormalities and those with extrarenal abnormalities (non-isolated cases) were determined and compared. RESULTS CMA detected chromosomal abnormalities in 78 of 577 fetuses (13.52%). WES detected monogenic variants in 31 of 160 fetuses (19.38%) that had non-diagnostic CMA results. In cases of isolated hyperechogenic kidney, polycystic kidney disease, and multicystic dysplastic kidney, the detection rates of copy number variants (CNVs) by CMA and monogenic variants by WES were not significantly different (P > 0.05). However, monogenic variants were more frequently detected than CNVs when kidney abnormalities were accompanied by reduced amniotic fluid (P < 0.05). Other renal abnormalities identified on prenatal ultrasound had different detection rates. CONCLUSIONS Our findings contribute to the overall knowledge of genetic variants associated with prenatally identified renal anomalies and may aid in decision making regarding prenatal genetic testing options for affected pregnancies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ling Liu
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Li
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Li
- Molecular Genetics Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyu Li
- Molecular Genetics Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Yang
- Molecular Genetics Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Fan
- Department of Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Wang
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanting Gu
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Yu
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Maohuan Bai
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tantan Yu
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shihong Cui
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guomei Cheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchen Ren
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Diagnostic accuracy of an interdisciplinary tertiary center evaluation in children referred for suspected congenital anomalies of the kidney and urinary tract on fetal ultrasound - a retrospective outcome analysis. Pediatr Nephrol 2021; 36:3885-3897. [PMID: 34128097 PMCID: PMC8599352 DOI: 10.1007/s00467-021-05139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/01/2021] [Accepted: 05/14/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fetal ultrasound organ screening has become a standard of care in most high-income countries. This has resulted in increased detection of congenital abnormalities, which may lead to major uncertainty and anxiety in expectant parents, even though many of them are of minor relevance. In order to optimize prenatal counselling, we introduced an interdisciplinary approach for all pregnant women referred to our center by private obstetricians for a co-assessment of suspected relevant fetal abnormalities of the kidney or urinary tract, involving both experienced prenatal ultrasound specialists and a pediatric nephrologist or urologist. METHODS In a retrospective analysis, we evaluated reports of intrauterine evaluation and postnatal follow-up in order to assess accuracy of explicit intrauterine diagnoses and outcome of hydronephroses according to their severity in this setting. RESULTS A total of 175 fetuses were examined between 2012 and 2019 and followed postnatally at our Pediatric Nephrology or Urology Department. There was a high concordance (85.9%) between explicit intrauterine and final diagnoses. Resolution rate of hydronephrosis was higher in patients with intrauterine low-grade than high-grade hydronephrosis (61.8% versus 11.9%). An etiological diagnosis was found in 62.5%, 52.0%, and 11.1% of patients with intrauterine bilateral high-grade, unilateral high-grade, and unilateral high-grade with contralateral low-grade hydronephrosis, respectively, but in none of the patients with intrauterine low-grade hydronephrosis. CONCLUSIONS The results of our study demonstrate that, through interdisciplinary teamwork, intrauterine assessment of the fetal kidneys and urinary tract is highly accurate and allows a good discrimination between relevant and transient/physiological hydronephroses. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Yalçınkaya F, Özçakar ZB. Management of antenatal hydronephrosis. Pediatr Nephrol 2020; 35:2231-2239. [PMID: 31811536 DOI: 10.1007/s00467-019-04420-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Antenatal hydronephrosis (AHN) is the most frequently detected abnormality by prenatal ultrasonography. Differential diagnosis of AHN includes a wide variety of congenital abnormalities of the kidney and urinary tract ranging from mild abnormalities such as transient or isolated AHN to more important ones as high-grade congenital vesicoureteral reflux or ureteropelvic junction obstruction. It is well known that the outcome depends on the underlying etiology. Various grading systems have been proposed for the classification of AHN on prenatal and postnatal ultrasonography. Mild isolated AHN represents up to 80% of cases, is considered to be benign, and majority of them resolve, stabilize, or improve during follow-up. Controversies exist regarding the diagnosis and management of some important and severe causes of AHN such as high-grade vesicoureteral reflux and ureteropelvic junction obstruction. Current approach is becoming increasingly conservative during diagnosis and follow-up of these patients with less imaging and close follow-up. However, there is still no consensus regarding the clinical significance, postnatal evaluation, and management of infants with AHN. The aim of this review is to discuss the controversies and provide an overview on the management of AHN.
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Affiliation(s)
- Fatoş Yalçınkaya
- Department of Pediatrics, Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey. .,Çocuk Hastanesi, Çocuk Nefroloji B.D, Ankara Üniversitesi Tıp Fakültesi, Dikimevi, 06100, Ankara, Turkey.
| | - Z Birsin Özçakar
- Department of Pediatrics, Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Bakalis S, Cao K, Graham R, Cuckow P, Johal N, Winyard P, Pandya P, Desai D. Outcomes of urinary tract abnormalities diagnosed by the routine third trimester scan. Eur J Obstet Gynecol Reprod Biol 2020; 250:150-154. [PMID: 32442840 DOI: 10.1016/j.ejogrb.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to determine the incidence of congenital abnormalities of the kidneys and urinary tract (CAKUT) detected for the first time in an unselected population undergoing a routine third trimester scan between 30-34 week's gestation. METHODS This was a retrospective analysis of 8562 routine third trimester ultrasound scans during which the fetal anatomy was evaluated, and, any structural abnormalities detected, recorded onto a fetal database which was subsequently analysed for CAKUT. All postnatal records of antenatally diagnosed CAKUT were obtained and analysed for diagnosis and management. RESULTS There were 26 cases of urological abnormalities detected for the first time in the third trimester. The most frequent abnormality was unilateral renal pelvis dilatation (73%). Postnatal ultrasound confirmed abnormalities in 19 (73%) newborns, with two (8%) resolving antenatally and four (15%) postnatally. The overall incidence of new CAKUT detected by the third trimester scan was 0.22% (19/8562) with a male to female ratio of 1:1.6. Four patients required surgery, two received cystoscopic injection of Deflux with circumcision, one received cystoscopic valve ablation and one patient received a staged hypospadias repair. CONCLUSION Routine third trimester scanning is already performed in many countries with proposed benefits primarily directed towards the monitoring of fetal growth and late pregnancy malpresentation. For healthcare systems that still utilize two routine scans, debate is ongoing as to the value of introducing a routine third trimester scan. The ability to detect additional and potentially missed CAKUT is a further benefit, which in isolation is likely of too small an impact to merit implementation. However, the combination of fetal structural assessment, growth velocity monitoring and fetal presentation evaluation presents a strong case for inclusion in an antenatal screening program. The findings of this study highlight the importance of a detailed fetal structural evaluation at each antenatal ultrasound scan.
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Affiliation(s)
- Spyros Bakalis
- Department of Obstetrics, Fetal and Maternal Medicine, Guy's and St Thomas NHS Trust, London, UK.
| | - Kevin Cao
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Radha Graham
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - Peter Cuckow
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Nav Johal
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Winyard
- Department of Nephrology, Great Ormond Street Hospital for Children, London, UK
| | - Pranav Pandya
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Divyesh Desai
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
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7
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Prenatal detection of congenital anomalies and related factors in Argentina. J Community Genet 2020; 11:313-320. [PMID: 31900752 DOI: 10.1007/s12687-019-00451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Congenital anomalies (CAs) are a leading cause of neonatal death. Many CAs can be diagnosed prenatally. To estimate the prenatal detection rate (PDR) of CA in hospitals participating in the RENAC (National Network of Congenital Anomalies of Argentina) and to analyze the PDR according to different factors. Sources were reports of RENAC from the 2013-2016 period. Congenital anomalies included were those detectable by ultrasound or by a prenatal karyotype. PDR was calculated by region, health subsector, clinical presentation, maternal age, sex, and twining. Using multiple logistic regression analysis, we evaluated predictors of prenatal detection. In total, 9976 cases were defined as prenatal detectable; 5021 were detected (PDR = 50.3%). Multiple presentation increased the chances of prenatal detection (Adj. OR = 1.6; 95%CI 1.4-1.9). Prenatal detection was lower in the public subsector (Adj. OR = 0.8; 95%CI 0.7-0.9) and in the northern regions of the country. PDR was higher than 75% in isolated cases of urinary malformation, anencephaly, and gastroschisis. Prenatal detection increased the chance of birth in higher complexity-level hospitals (Adj. OR = 2.5; 95%CI 2.3-2.8). PDR was within the range previously reported. Heterogeneity between regions and health subsector suggests the need for training to achieve equity in detection.
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Loardi C, Signorelli M, Gregorini M, Marella D, Torri F, Zambelloni CM, Omodei U, Odicino F. Moderate and severe fetal pyelectasis: Correlation between prenatal aspects and postnatal outcome. J Neonatal Perinatal Med 2020; 13:91-96. [PMID: 31609706 DOI: 10.3233/npm-180071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. METHODS A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. RESULTS Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12-25 mm) compared to the group B (11 mm, IQR 10-14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. CONCLUSION Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.
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Affiliation(s)
- C Loardi
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - M Signorelli
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - M Gregorini
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - D Marella
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - F Torri
- Department of Pediatric Surgery, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - C Mario Zambelloni
- Department of Neonatology, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - U Omodei
- Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - F Odicino
- Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, University of Brescia, Italy
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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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Barbosa RM, Souza RT, Silveira C, Andrade KC, Almeida CM, Bortoleto AG, Oliveira PF, Cecatti JG. Reference ranges for ultrasound measurements of fetal kidneys in a cohort of low-risk pregnant women. Arch Gynecol Obstet 2019; 299:585-591. [PMID: 30607595 DOI: 10.1007/s00404-018-5032-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Alterations in renal dimensions may be an early manifestation of deviation from normality, with possible repercussions beyond intrauterine life. The objective of this study was to establish reference curves for fetal kidney dimensions and volume from 14 to 40 weeks of gestation. METHODS This is a prospective longitudinal study of 115 Brazilian participants in the "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component". Pregnant women with clinical and sociodemographic characteristics allowing the full potential fetal growth were followed up from the first trimester until delivery. These women underwent serial sonographic evaluation of fetal kidneys. The longitudinal, anteroposterior and transverse diameters of both fetal kidneys were measured, in addition to calculation of kidney volume. By quantile regression analysis, reference curves of renal measurements related to gestational age were built. RESULTS Standard normal sonographic values of renal biometry were defined during pregnancy. Reference values for the 10th, 50th and 90th centiles of different fetal kidney measurements (longitudinal, anteroposterior, transverse and volume) from the 14th to the 40th week of gestation were fitted. CONCLUSION The reference curves presented should be of the utmost importance for screening and diagnosis of alterations in renal development during the intrauterine period.
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Affiliation(s)
- Ricardo M Barbosa
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Renato T Souza
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Carla Silveira
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Kleber C Andrade
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Cristiane M Almeida
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Ana G Bortoleto
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Paulo F Oliveira
- Statistics Unit, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil.
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11
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Sharma S, Bhanot R, Deka D, Bajpai M, Gupta DK. Impact of fetal counseling on outcome of antenatal congenital surgical anomalies. Pediatr Surg Int 2017; 33:203-212. [PMID: 27864598 DOI: 10.1007/s00383-016-4015-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 12/27/2022]
Abstract
AIM To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA). METHODS Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome. RESULTS 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17-37;17-39 weeks (median 24;32 weeks). Diagnoses in ACSA;PACSA included urological (26;31), neurological (10;5), congenital diaphragmatic hernia (CDH)(5;1), gastrointestinal (5;5), lung and chest anomalies (5;1), intraabdominal cysts (4;1), abdominal wall defects (4;0), tumors (3;3), limb anomaly (1;1), esophageal atresia (1;1), conjoint twins (1;0), hepatomegaly (1;0), and major cardiac anomalies (2;0). Two antenatal interventions were done for ACSA; vesicoamniotic shunt and amnioinfusion for oligohydramnios. 17;24 ACSA;PACSA required early surgical intervention in post-natal period. Nine ACSA underwent medical termination of pregnancy and 4 had intrauterine demise. Nine ACSA babies died including two CDH, one gastroschisis, one duodenal atresia, one conjoint twins, one megacystitis with motility disorder and three posterior urethral valves. All PACSA babies survived. CONCLUSION Fetal counseling for CSA portrays true outcome of ACSA with 32.3% (22/68) mortality versus 0% for PACSA due to selection bias. However, fetal counseling ensures optimal perinatal care.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ranjana Bhanot
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Recent advances in pediatric urinary tract imaging include development of alternative imaging methods without use of ionizing radiation; evolving understanding of the relationship of urinary tract infection, vesicoureteral reflux, and renal scarring, including the important role of dysfunctional voiding; development of a consensus nomenclature and risk-based classification for fetal and antenatal urinary tract dilation; advances in the understanding of sporadic and inherited renal cystic disease; and a proposed modification of the Bosniak criteria for distinguishing complex renal cysts from cystic renal tumors in children.
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Andrés-Jensen L, Jørgensen FS, Thorup J, Flachs J, Madsen JL, Maroun LL, Nørgaard P, Vinicoff PG, Olsen BH, Cortes D. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child 2016; 101:819-24. [PMID: 27217581 DOI: 10.1136/archdischild-2015-309784] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/29/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Antenatal ultrasound diagnosed anomalies of the kidney and urinary tract (AUDAKUT) are reported in 0.3%-5% on prenatal ultrasound (US) and 0.3%-4.5% on postnatal US. The anterior-posterior diameter of the renal pelvis (APD) is an essential measurement. Series with low threshold values of APD prenatally and postnatally will include healthy infants. It is important to avoid follow-up of such infants. INTERVENTIONS In 2006, new Danish guidelines for AUDAKUT were introduced. AIM OF STUDY Investigations of incidences and type of AUDAKUT based on Danish guidelines, including long-term follow-up. DESIGN Cohort study. SETTING Copenhagen University Hospital Hvidovre and Copenhagen University Hospital Rigshospitalet, Denmark. PATIENTS Consecutive cases with AUDAKUT in the second and third trimesters, which were either terminated before 22 completed weeks of gestation or born in the 8-year period January 2006-December 2013. Patients were followed until June 2014. RESULTS 50 193 live born children and 24 terminated fetuses (0.05%) were included. The prevalence of AUDAKUT was only 0.39% prenatally, 0.29% at first postnatal US and 0.22% at the end of follow-up, including terminated cases. The greater the prenatal and postnatal APD, the higher risk of febrile urinary tract infection (fUTI) and surgical intervention, and lower probability of resolution. 25% of the identified patients had fUTI and/or surgery. CONCLUSIONS We recommend threshold values of APD at least 10 mm in the third trimester and in general at least 12 mm at first postnatal US for intensive follow-up. In this largest to date unselected birth cohort of AUDAKUT, the incidences of clinically significant AUDAKUT were in the lowest range of those previously published.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Finn Stener Jørgensen
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Flachs
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jan Lysgaard Madsen
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lisa Leth Maroun
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernille Nørgaard
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Pablo Gustavo Vinicoff
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Beth Härstedt Olsen
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Dina Cortes
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Shalaby H, Hemida R, Nabil H, Ibrahim M. Types and Outcome of Fetal Urinary Anomalies in Low Resource Setting Countries: A Retrospective Study. J Obstet Gynaecol India 2016; 66:316-20. [PMID: 27486275 DOI: 10.1007/s13224-015-0675-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/16/2015] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Congenital anomalies of the kidney and urinary tract in the developing countries have a poor prognosis due to limited experience in antenatal and postnatal management. PATIENTS AND METHODS A 3-year retrospective study was carried out from January 2011 to December 2013. The following data were collected and analyzed: maternal age, gravidity, parity, gestational age at diagnosis, and ultrasonography findings. Final diagnosis after birth, the performed surgeries, follow-up data, as well as survival at one year were also analyzed. RESULTS The mean age of the included patients was 28 years (range 20-35 years). The mean parity was 1.7 (range 0-4). The mean gestational age at diagnosis was 26 weeks (range 15-36 weeks). Consanguinity was reported in 10 cases (24.4 %). There were 25 males and 16 females. Bilateral renal agenesis was the commonest type (19.5 %). The anomalies of kidneys and urinary tract in our cases were associated with other anomalies in 8 cases (19.5 %). Oligohydramnios was detected in bilateral renal agenesis and posterior urethral valve. Surgical interference during the first 6 months was performed in 6 cases; pyeloplasty for unilateral or bilateral hydronephrosis was performed in 5 cases; and excision of solitary renal cyst performed in one case. By the end of the first year, two of the three cases with chronic renal disease, who were under peritoneal dialysis, died, and three cases who had undergone pyeloplasty were lost to follow-up. CONCLUSION Among the 41 cases with antenatally diagnosed renal and urinary malformations; bilateral renal agenesis was the commonest anomaly (19.5 %). There were high rates of induction of abortion, IUFD, and neonatal deaths. The poor outcome may be due to lack of experience in performing invasive therapeutic fetal procedures.
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Abstract
PURPOSE OF REVIEW The prenatal detection of congenital anomalies of the kidney and urinary tract (CAKUT) has permitted the early management of these conditions. The aim of this review is to provide an overview of the management of neonates with antenatal hydronephrosis (ANH). RECENT FINDINGS In spite of the continuous advances in the understanding of the genetic basis, clinical course, and outcomes of CAKUT, there are still many controversies regarding the clinical significance, postnatal evaluation, and management of neonates with ANH. Mild ANH will often resolve spontaneously, whereas moderate to severe ANH is frequently associated with CAKUT. SUMMARY ANH is a surrogate marker of potential congenital renal anomalies, but usually cannot identify a specific disease. A multidisciplinary team approach is required to diagnose and treat these complex disorders. Currently nonsurgical management of CAKUT should be considered whenever possible for infants with ANH.
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Sadeghi-Bojd S, Kajbafzadeh AM, Ansari-Moghadam A, Rashidi S. Postnatal Evaluation and Outcome of Prenatal Hydronephrosis. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e3667. [PMID: 27307966 PMCID: PMC4906562 DOI: 10.5812/ijp.3667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/22/2015] [Accepted: 12/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prenatal hydronephrosis (PNH) is dilation in urinary collecting system and is the most frequent neonatal urinary tract abnormality with an incidence of 1% to 5% of all pregnancies. PNH is defined as anteroposterior diameter (APD) of renal pelvis ≥ 4 mm at gestational age (GA) of < 33 weeks and APD ≥ 7 mm at GA of ≥ 33 weeks to 2 months after birth. All patients need to be evaluated after birth by postnatal renal ultrasonography (US). In the vast majority of cases, watchful waiting is the only thing to do; others need medical or surgical therapy. OBJECTIVES There is a direct relationship between APD of renal pelvis and outcome of PNH. Therefore we were to find the best cutoff point APD of renal pelvis which leads to surgical outcome. PATIENTS AND METHODS In this retrospective cohort study we followed 200 patients 1 to 60 days old with diagnosis of PNH based on before or after birth ultrasonography; as a prenatal or postnatal detected, respectively. These patients were referred to the nephrology clinic in Zahedan Iran during 2011 to 2013. The first step of investigation was a postnatal renal US, by the same expert radiologist and classifying the patients into 3 groups; normal, mild/moderate and severe. The second step was to perform voiding cystourethrogram (VCUG) for mild/moderate to severe cases at 4 - 6 weeks of life. Tc-diethylene triamine-pentaacetic acid (DTPA) was the last step and for those with normal VCUG who did not show improvement in follow-up examination, US to evaluate obstruction and renal function. Finally all patients with mild/moderate to severe PNH received conservative therapy and surgery was preserved only for progressive cases, obstruction or renal function ≤35%. All patients' data and radiologic information was recorded in separate data forms, and then analyzed by SPSS (version 22). RESULTS 200 screened PNH patients with male to female ratio 3.5:1 underwent first postnatal control US, of whom 65% had normal, 18% mild/moderate and 17% severe hydronephrosis. 167 patients had VCUG of whom 20.82% with VUR. 112 patients performed DTPA with following results: 50 patients had obstruction and 62 patients showed no obstructive finding. Finally 54% of 200 patients recovered by conservative therapy, 12.5% by surgery and remaining improved without any surgical intervention. CONCLUSIONS The best cutoff point of anteroposterior renal pelvis diameter that led to surgery was 15 mm, with sensitivity 88% and specificity 74%.
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Affiliation(s)
- Simin Sadeghi-Bojd
- Research Center for Children and Adolescents, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Simin Sadeghi-Bojd, Research Center for Children and Adolescents, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-5412440482, Fax: +98-5413425596, E-mail:
| | - Abdol-Mohammad Kajbafzadeh
- Department of Urology, Pediatric Urology Research Center, Children’s Medical Center, Tehran University of Medical Sciences,Tehran, IR Iran
| | | | - Somaye Rashidi
- Research Center for Children and Adolescents, Zahedan University of Medical Sciences, Zahedan, IR Iran
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Seven A, Savran B, Koçak E, Tok S, Yüksel KB, Gözükara İ, Kabil Kucur S. Is there a correlation between maternal serum TGF-β1 levels and fetal hydronephrosis? J Matern Fetal Neonatal Med 2015; 29:1113-6. [DOI: 10.3109/14767058.2015.1036022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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