open access
Predictors of poor neonatal outcomes in fetuses diagnosed with congenital urinary tract anomalies
Affiliations- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Serbia
open access
Abstract
Objectives: Urinary tract anomalies account for approximately one-quarter of all antenatally detected anomalies. The aim of this study was to identify factors associated with severe adverse neonatal outcomes of a prenatally diagnosed urinary tract anomaly.
Material and methods: A retrospective-prospective study included 101 pregnant women with prenatally diagnosed fetal urinary tract anomalies presented to the Council for Fetal Anomalies. Prenatal diagnoses were compared with autopsy findings in cases of terminated pregnancy or with clinical and operative findings of the infants.
Results: The mortality rate in the group of patients with fetal obstructive uropathy (60 patients) was 10% and in the group of patients with fetal multicystic dysplastic kidney (38 patients) 15.7%. Surgery was performed on 53.4% of the children, whereas more than half of the operations involved resolving associated urinary tract anomalies. Postoperative renal function deterioration occurred in 19% of the children.
Conclusions: The prognosis of renal function in obstructive uropathies is excellent if oligoamnios does not develop prenatally and in case of timely provided surgical care is provided postnatally. The finding of the bilateral multicystic dysplastic kidney is associated with poor prognosis. The prognosis in fetal unilateral multicystic dysplastic kidney depends primarily on the condition of the contralateral kidney and the existence of associated anomalies.
Abstract
Objectives: Urinary tract anomalies account for approximately one-quarter of all antenatally detected anomalies. The aim of this study was to identify factors associated with severe adverse neonatal outcomes of a prenatally diagnosed urinary tract anomaly.
Material and methods: A retrospective-prospective study included 101 pregnant women with prenatally diagnosed fetal urinary tract anomalies presented to the Council for Fetal Anomalies. Prenatal diagnoses were compared with autopsy findings in cases of terminated pregnancy or with clinical and operative findings of the infants.
Results: The mortality rate in the group of patients with fetal obstructive uropathy (60 patients) was 10% and in the group of patients with fetal multicystic dysplastic kidney (38 patients) 15.7%. Surgery was performed on 53.4% of the children, whereas more than half of the operations involved resolving associated urinary tract anomalies. Postoperative renal function deterioration occurred in 19% of the children.
Conclusions: The prognosis of renal function in obstructive uropathies is excellent if oligoamnios does not develop prenatally and in case of timely provided surgical care is provided postnatally. The finding of the bilateral multicystic dysplastic kidney is associated with poor prognosis. The prognosis in fetal unilateral multicystic dysplastic kidney depends primarily on the condition of the contralateral kidney and the existence of associated anomalies.
Keywords
fetus; congenital; urinary tract; anomalies; outcome
About this articleTitle
Predictors of poor neonatal outcomes in fetuses diagnosed with congenital urinary tract anomalies
Journal
Issue
Article type
Research paper
Pages
607-610
Published online
2021-04-08
Page views
1028
Article views/downloads
755
DOI
Pubmed
Bibliographic record
Ginekol Pol 2021;92(9):607-610.
Keywords
fetus
congenital
urinary tract
anomalies
outcome
Authors
Sonja Pop-Trajkovic Dinic
Radomir Zivadinovic
Milan Stefanovic
Milan Trenkic
Jelena Milosevic
Dejan Mitic
References (21)- Li ZY, Chen YM, Qiu LQ, et al. Prevalence, types, and malformations in congenital anomalies of the kidney and urinary tract in newborns: a retrospective hospital-based study. Ital J Pediatr. 2019; 45(1): 50.
- Postoev VA, Grjibovski AM, Kovalenko AA, et al. Congenital anomalies of the kidney and the urinary tract: A murmansk county birth registry study. Birth Defects Res A Clin Mol Teratol. 2016; 106(3): 185–193.
- Dias T, Sairam S, Kumarasiri S. Ultrasound diagnosis of fetal renal abnormalities. Best Pract Res Clin Obstet Gynaecol. 2014; 28(3): 403–415.
- Capone VP, Morello W, Taroni F, et al. Genetics of Congenital Anomalies of the Kidney and Urinary Tract: The Current State of Play. Int J Mol Sci. 2017; 18(4).
- Lei TY, Fu F, Li Ru, et al. Whole-exome sequencing for prenatal diagnosis of fetuses with congenital anomalies of the kidney and urinary tract. Nephrol Dial Transplant. 2017; 32(10): 1665–1675.
- Miao Q, Shen Q, Xu H, et al. [Etiological analysis of 264 cases with chronic kidney disease stage 2 to 5 in children]. Zhonghua Er Ke Za Zhi. 2015; 53(9): 665–669.
- Jiang Y, Shen Y, Lau KK. Survey of chronic haemodialysis in children between 2007 and 2012 in China. Nephrology (Carlton). 2014; 19(7): 375–378.
- dos Santos Junior AC, de Miranda DM, Simões e Silva AC. Congenital anomalies of the kidney and urinary tract: an embryogenetic review. Birth Defects Res C Embryo Today. 2014; 102(4): 374–381.
- Chen L, Guan J, Gu H, et al. Outcomes in fetuses diagnosed with megacystis: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019; 233: 120–126.
- Babu R, Sai V. Postnatal outcome of fetal hydronephrosis: implications for prenatal counselling. Indian J Urol. 2010; 26(1): 60–62.
- Zhang T, Wu S. Prenatal ultrasound diagnosis of 1 case of vesicoureteral reflux. Quant Imaging Med Surg. 2016; 6(3): 320–322.
- Sharma G. Postnatal management of antenatally detected hydronephrosis. World Journal of Clinical Urology. 2014; 3(3): 283.
- Marzuillo P, Guarino S, Grandone A, et al. Outcomes of a Cohort of Prenatally Diagnosed and Early Enrolled Patients with Congenital Solitary Functioning Kidney. J Urol. 2017; 198(5): 1153–1158.
- Ramanathan S, Kumar D, Khanna M, et al. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract. World J Radiol. 2016; 8(2): 132–141.
- Ralli M, Agarwal S, Badhe B, et al. Unilateral multicystic dysplastic kidney with ipsilateral grade V vesicoureteral reflux: A case report of a rare association. Medical Journal of Dr. D.Y. Patil University. 2017; 10(5): 479.
- Stoll C, Dott B, Alembik Y, et al. Associated nonurinary congenital anomalies among infants with congenital anomalies of kidney and urinary tract (CAKUT). Eur J Med Genet. 2014; 57(7): 322–328.
- Balasundaram M, Chock VY, Wu HY, et al. Predictors of poor neonatal outcomes in prenatally diagnosed multicystic dysplastic kidney disease. J Perinatol. 2018; 38(6): 658–664.
- Psooy K. Multicystisc displastic kidney in the neonate: The role of the urologist. Can Urol Assoc J. 2016; 10(1-2): 18–24.
- Andrés-Jensen L, Jørgensen FS, Thorup J, et al. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child. 2016; 101(9): 819–824.
- 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.
- Bakker MK, Bergman JEH, Fleurke-Rozema H, et al. Prenatal diagnosis of urinary tract anomalies, a cohort study in the Northern Netherlands. Prenat Diagn. 2018; 38(2): 130–134.
