Defining and predicting 'intrauterine fetal renal failure' in congenital lower urinary tract obstruction

被引:39
|
作者
Ruano, Rodrigo [1 ,7 ]
Safdar, Adnan [2 ,7 ]
Au, Jason [3 ,7 ]
Koh, Chester J. [3 ,7 ]
Gargollo, Patricio [3 ,7 ]
Shamshirsaz, Alireza A. [1 ,7 ]
Espinoza, Jimmy [1 ,7 ]
Cass, Darrell L. [4 ,7 ]
Olutoye, Oluyinka O. [4 ,7 ]
Olutoye, Olutoyin A. [5 ,7 ]
Welty, Stephen [6 ,7 ]
Roth, David R. [3 ,7 ]
Belfort, Michael A. [1 ,7 ]
Braun, Michael C. [2 ,7 ]
机构
[1] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Dept Obstet & Gynecol, Houston, TX USA
[2] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Renal Sect, Houston, TX USA
[3] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Div Pediat Urol, Houston, TX USA
[4] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Dept Pediat Surg, Houston, TX USA
[5] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Dept Anesthesiol, Houston, TX USA
[6] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, Dept Pediat, Houston, TX USA
[7] Texas Childrens Hosp Pavil Women, Baylor Coll Med, Texas Childrens Fetal Ctr, 6651 Main St,Suite F1020, Houston, TX 77030 USA
关键词
Fetal lower urinary tract obstruction; Posterior urethral valves; Vesicoamniotic shunt; Prenatal diagnosis; Ultrasonography; Fetal surgery; Renal function; POSTERIOR URETHRAL VALVES; TRANSURETHRAL STENT; CYSTOSCOPY; INTERVENTION; BIOCHEMISTRY; EXPERIENCE; MANAGEMENT; PLACEMENT; OUTCOMES; CHILDREN;
D O I
10.1007/s00467-015-3246-8
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background The aim of this study was to identify predictors of 'intrauterine fetal renal failure' in fetuses with severe congenital lower urinary tract obstruction (LUTO). Methods We undertook a retrospective study of 31 consecutive fetuses with a diagnosis of LUTO in a tertiary Fetal Center between April 2013 and April 2015. Predictors of 'intrauterine fetal renal failure' were evaluated in those infants with severe LUTO who had either a primary composite outcome measure of neonatal death in the first 24 h of life due to severe pulmonary hypoplasia or a need for renal replacement therapy within 7 days of life. The following variables were analyzed: fetal bladder re-expansion 48 h after vesicocentesis, fetal renal ultrasound characteristics, fetal urinary indices, and amniotic fluid volume. Results Of the 31 fetuses included in the study, eight met the criteria for 'intrauterine fetal renal failure'. All of the latter had composite poor postnatal outcomes based on death within 24 h of life (n= 6) or need for dialysis within 1 week of life (n= 2). The percentage of fetal bladder refilling after vesicocentesis at time of initial evaluation was the only predictor of 'intrauterine fetal renal failure' (cut-off < 27 %, area under the time-concentration curve 0.86, 95 % confidence interval 0.68-0.99; p= 0.009). Conclusion We propose the concept of 'intrauterine fetal renal failure' in fetuses with the most severe forms of LUTO. Fetal bladder refilling can be used to reliably predict 'intrauterine fetal renal failure', which is associated with severe pulmonary hypoplasia or the need for dialysis within a few days of life.
引用
收藏
页码:605 / 612
页数:8
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