open access
Neonatal survival and kidney function after prenatal interventions for obstructive uropathies
, 2, 2, 2, 3, 4, 4, 5, 6, 7, 7, 8, 2
Affiliations- Department of Paediatics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute of Lodz, Lodz, Poland
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Intensive Therapy and Congenital Malformations of Newborns and Infants, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Neonatology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Surgery, Urology and Transplantology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Imaging Diagnostic, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Medical Laboratory Diagnostic Centre, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
open access
Abstract
Objectives: Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses.
Material and methods: The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13–30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period.
Results: From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performer at the mean 21 week of pregnancy (range 14–30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low — 18% (7/39).
Conclusions: Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.
Abstract
Objectives: Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses.
Material and methods: The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13–30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period.
Results: From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performer at the mean 21 week of pregnancy (range 14–30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low — 18% (7/39).
Conclusions: Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.
Keywords
obstructive uropathy; posterior urethral valves; vesico-amniotic shunting; kidney function; prenatal; neonate
About this articleTitle
Neonatal survival and kidney function after prenatal interventions for obstructive uropathies
Journal
Issue
Article type
Research paper
Pages
416-422
Published online
2019-07-26
Page views
1473
Article views/downloads
1040
DOI
Bibliographic record
Ginekol Pol 2019;90(7):416-422.
Keywords
obstructive uropathy
posterior urethral valves
vesico-amniotic shunting
kidney function
prenatal
neonate
Authors
Marcin Tkaczyk
Malgorzata Stanczyk
Waldemar Krzeszowski
Justyna Wojtera
Magdalena Litwinska
Katarzyna Fortecka-Piestrzeniewicz
Tomasz Talar
Barbara Pawlowska
Dariusz Olejniczak
Michal Podgorski
Rafal Swiechowski
Adrian Krygier
Agnieszka Wosiak
Krzysztof Szaflik
References (19)- Farrugia MK. Fetal bladder outlet obstruction: Embryopathology, in utero intervention and outcome. J Pediatr Urol. 2016; 12(5): 296–303.
- Clayton D, Brock J. Current State of Fetal Intervention for Lower Urinary Tract Obstruction. Curr Urol Rep. 2018; 19(1).
- Smith-Harrison LI, Hougen HY, Timberlake MD, et al. Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol. 2015; 11(6): 341–347.
- Nef S, Neuhaus TJ, Spartà G, et al. Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract. Eur J Pediatr. 2016; 175(5): 667–676.
- Ruano R, Sananes N, Sangi-Haghpeykar H, et al. Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol. 2015; 45(4): 452–458.
- Morris RK, Middleton LJ, Malin GL, et al. PLUTO Collaborative Group. Outcome in fetal lower urinary tract obstruction: a prospective registry study. Ultrasound Obstet Gynecol. 2015; 46(4): 424–431.
- Pope JC, Brock JW, Adams MC, et al. How they begin and how they end: classic and new theories for the development and deterioration of congenital anomalies of the kidney and urinary tract, CAKUT. J Am Soc Nephrol. 1999; 10(9): 2018–2028.
- Morris RK, Malin GL, Quinlan-Jones E, et al. Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) Collaborative Group. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013; 382(9903): 1496–1506.
- Nassr AA, Shazly SAM, Abdelmagied AM, et al. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017; 49(6): 696–703.
- Rudd PT, Hughes EA, Placzek MM, et al. Reference ranges for plasma creatinine during the first month of life. Arch Dis Child. 1983; 58(3): 212–215.
- Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr. 1984; 104(6): 849–854.
- Gubhaju L, Sutherland MR, Horne RSC, et al. Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol. 2014; 307(2): F149–F158.
- Sananes N, Cruz-Martinez R, Favre R, et al. Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 2016; 36(4): 297–303.
- Ethun CG, Zamora IJ, Roth DR, et al. Outcomes of fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt: a single-institution experience. J Pediatr Surg. 2013; 48(5): 956–962.
- Jeong BD, Won HS, Lee MY. Perinatal Outcomes of Fetal Lower Urinary Tract Obstruction After Vesicoamniotic Shunting Using a Double-Basket Catheter. J Ultrasound Med. 2018; 37(9): 2147–2156.
- Fontanella F, van Scheltema PN, Duin L, et al. Antenatal staging of congenital lower urinary tract obstruction. Ultrasound Obstet Gynecol. 2019; 53(4): 520–524.
- Martínez JM, Masoller N, Devlieger R, et al. Laser ablation of posterior urethral valves by fetal cystoscopy. Fetal Diagn Ther. 2015; 37(4): 267–273.
- Johnson MP, Danzer E, Koh J, et al. North American Fetal Therapy Network (NAFTNet). Natural History of Fetal Lower Urinary Tract Obstruction with Normal Amniotic Fluid Volume at Initial Diagnosis. Fetal Diagn Ther. 2018; 44(1): 10–17.
- Matsell DG, Yu S, Morrison SJ. Antenatal Determinants of Long-Term Kidney Outcome in Boys with Posterior Urethral Valves. Fetal Diagn Ther. 2016; 39(3): 214–221.
