Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in second trimester of pregnancy.
Adult
Amniotic Fluid
/ diagnostic imaging
Child, Preschool
Female
Fetal Diseases
/ diagnostic imaging
Humans
Infant
Infant, Newborn
Oligohydramnios
/ diagnostic imaging
Perinatal Mortality
Pregnancy
Pregnancy Trimester, Second
Renal Insufficiency, Chronic
/ diagnosis
Retrospective Studies
Risk Assessment
Ultrasonography
/ methods
Urethral Obstruction
/ congenital
Urologic Diseases
/ congenital
LUTO
chronic renal disease
dialysis
obstructive uropathy
pulmonary hypoplasia
vesicoamniotic shunt
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
02
02
2019
revised:
15
03
2019
accepted:
05
04
2019
pubmed:
13
4
2019
medline:
17
3
2020
entrez:
13
4
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
500-505Informations de copyright
Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Références
Anumba DO, Scott JE, Plant ND, Robson SC. Diagnosis and outcome of fetal lower urinary tract obstruction in the northern region of England. Prenat Diagn 2005; 25: 7-13.
Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K, Burke D, Daniels JP, Khan KS, Deeks J, Kilby MD; 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: 1496-1506.
Haeri S. Fetal Lower Urinary Tract Obstruction (LUTO): a practical review for providers. Matern Health Neonatol Perinatol 2015; 1: 26.
Nassr AA, Shazly SA, Abdelmagied AM, Araujo Junior 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 Obstet Gynecol 2017; 49: 696-703.
Morris R, Malin G, Khan K, Kilby M. Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG 2009; 116: 1290-1299.
Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990; 162: 1168-1173.
Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Safdar A, Moaddab A, Meyer N, Cass DL et al. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol 2016; 48: 476-482.
Nassr AA, Koh CK, Shamshirsaz AA, Espinoza J, Sangi-Haghpeykar H, Sharhan D, Welty S, Angelo J, 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.
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629-637.
Behrman RE, Swischuk LE, Richardson CJ, Nichols MM, Ingman MJ. Primary pulmonary hypoplasia in the neonate. J Pediatr 1979; 95: 573-577.
Mendelsohn G, Hutchins GM. Primary pulmonary hypoplasia: report of a case with polyhydramnios. Am J Dis Child 1977; 131: 1220-1223.
Moerman P, Vanhole C, Devlieger H, Fryns JP. Severe primary pulmonary hypoplasia (“acinar dysplasia”) in sibs: a genetically determined mesodermal defect? J Med Genet 1998; 35: 964-965.
Ruano R, Safdar A, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Belfort MA, Braun MC. Defining and predicting ‘intrauterine fetal renal failure’ in congenital lower urinary tract obstruction. Pediatr Nephrol 2016; 31: 605-612.
González R, De Filippo R, Jednak R, Barthold JS. Urethral atresia: long-term outcome in 6 children who survived the neonatal period. J Urol 2001; 165: 2241-2244.
Johnson MP, Danzer E, Koh J, Polzin W, Harman C, O'Shaughnessy R, Brown R, Zaretsky MV; 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: 10-17.