Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract
| Autor: | Giuseppina Spartà, Josef Wisser, Rita Gobet, Ulrich V. Willi, Guido F. Laube, Thomas J. Neuhaus, Samuel Nef, Marcus Weitz, Kathrin Buder |
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| Přispěvatelé: | University of Zurich, Nef, Samuel |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Urologic Diseases medicine.medical_specialty Pediatrics Megaureter 030232 urology & nephrology Prenatal diagnosis Oligohydramnios 610 Medicine & health Kidney Vesicoureteral reflux Ultrasonography Prenatal 03 medical and health sciences 0302 clinical medicine Pregnancy Risk Factors 030225 pediatrics Cause of Death Prenatal Diagnosis medicine Humans Prospective Studies 2735 Pediatrics Perinatology and Child Health Prospective cohort study Urinary Tract Hydronephrosis 10026 Clinic for Obstetrics business.industry Incidence Infant Newborn Urography medicine.disease Renal dysplasia Surgery 10036 Medical Clinic Pediatrics Perinatology and Child Health Kidney Failure Chronic Urologic disease Female Kidney Diseases business Switzerland Follow-Up Studies |
| DOI: | 10.5167/uzh-129520 |
| Popis: | Congenital anomalies of the kidney and urinary tract are common findings on fetal ultrasound. The aim of this prospective observational study was to describe outcome and risk factors in 115 patients born 1995-2001. All prenatally diagnosed children were stratified into low- and high-risk group and followed postnatally clinically and by imaging at defined endpoints. Risk factors were evaluated using odds ratios. Neonatal diagnosis included pelvi-ureteric junction obstruction (n = 33), vesicoureteral reflux (n = 27), solitary mild pelvic dilatation (postnatal anteroposterior diameter 5-10 mm; n = 25), and further diagnosis as primary obstructive megaureter, unilateral multicystic dysplastic kidney, renal dysplasia and posterior urethral valves. In 38 children with prenatal isolated hydronephrosis, ultrasound normalized at median age of 1.2 years (range 0.1-9). Surgery was performed in 34 children at median age of 0.4 years (0.1-10.8). Persistent renal anomalies without surgery were present in 43 children and followed in 36 for median time of 16 years (12.2-18). Oligohydramnios and postnatal bilateral anomalies were significantly associated with surgery and impaired renal function.The majority of children had a favourable postnatal outcome, in particular children with prenatally low risk, i.e. isolated uni- or bilateral hydronephrosis. Oligohydramnios and postnatal bilateral anomalies were risk factors for non-favourable outcome.• In congenital anomalies of the kidney and urinary tract significantly poorer outcome is known in patients with bilateral renal hypoplasia or solitary kidney associated with posterior urethral valves. • Other factors as proteinuria and vesicoureteral reflux were associated with a higher risk of progression to chronic renal failure in these patients. What is New: • Unlike other studies giving us above-mentioned information, we included all patients with any kind of prenatally diagnosed congenital anomalies of the kidney and urinary tract. Our study shows long-term follow up (median 16 years, range 12.2-18 years), especially in patients not needing surgery, but with persistent anomalies. • During postnatal long-term follow up (median 2.2 years, range 0.1-18 years) one third each showed normalization, need of surgery or persistence of anomalies without need of surgery. Our study revealed a good prognosis in the majority of these children, in particular with prenatally low risk, i.e. isolated uni- or bilateral hydronephrosis, and revealed oligohydramnios and postnatal bilateral anomalies as risk factors for a non-favourable outcome, defined as need of surgery, persistent anomalies with impaired renal function, end stage renal failure or death. |
| Databáze: | OpenAIRE |
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