Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment.
LUTO
lower urinary tract obstruction
megacystis
metanephric blastema
prenatal surgery
renal dysplasia
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:
04 2022
04 2022
Historique:
revised:
05
06
2021
received:
26
04
2021
accepted:
14
06
2021
pubmed:
29
6
2021
medline:
6
4
2022
entrez:
28
6
2021
Statut:
ppublish
Résumé
To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery. This multicenter, retrospective study included male fetuses with severe LUTO which died before 24 weeks of gestation during the period January 2000 to December 2018. Age-matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and/or urine β2microglobulin level were retrieved and kidney histology slides (hematein-eosin-safran and α-smooth-muscle-actin (αSMA) immunostaining) were prepared and reviewed. αSMA-positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and αSMA labeling and the data of these groups were compared. Included in the study were 74 fetuses with a median gestational age at outcome of 17 + 6 (range, 13 + 0 to 23 + 5) weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and αSMA-negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died ≤ 18 weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (P = 0.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (P < 0.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early-unfavorable-prognosis group (≤ 18 weeks) and the group with a favorable prognosis (P = 0.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria. Before 18 weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
513-521Investigateurs
Julien J Stirnemann
(JJ)
Laurent J Salomon
(LJ)
Laurence Loeuillet
(L)
Maryse Bonnière
(M)
Houria Salhi
(H)
Nathalie Roux
(N)
Giulia Petrilli
(G)
Fabien Guimiot
(F)
Suonavy Khung-Savatovsky
(S)
Jonathan Rosenblatt
(J)
Thibaud Quibel
(T)
Brigitte Leroy
(B)
Vassilis Tsatsaris
(V)
Olivia Anselem
(O)
Gilles Grange
(G)
Jean-Marc Levaillant
(JM)
Naima Talhi
(N)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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