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Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract

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Abstract

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.

Conclusion: 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.

What is Known:

• 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.

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Abbreviations

ADPKD:

Autosomal dominant polycystic kidney disease

APD:

Anteroposterior diameter

CAKUT:

Congenital anomalies of the kidney and urinary tract

CRP:

C-reactive protein

DMSA:

Dimercaptosuccinic acid scintigraphy

ESRF:

End-stage renal failure

GFR:

Glomerular filtration rate

IVU:

Intravenous urography

MAG-3:

Mercaptoacetyltriglycine-3 scintigraphy

MCDK:

Multicystic dysplastic kidney

POM:

Primary obstructive megaureter

PUV:

Posterior urethral valves

PUJO:

Pelvi-ureteric junction obstruction

US:

Ultrasound

UTI:

Urinary tract infections

VCUG:

Voiding cystourethrography

VUR:

Vesicoureteral reflux

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Authors’contributions

Samuel Nef: paediatric nephrologist, main autor Thomas Neuhaus, Prof., M.D.: paediatic nephrologist, nephrological counselling, writting, revision Giuseppina Spartà, M.D.: paediatric nephrologist, nephrological counselling Marcus Weitz, M.D.: paediatric nephrologist, nephrological counselling Kathrin Buder, M.D.: statistics Josef Wisser, Prof., M.D.: obbstetrician, prenatal counselling Rita Gobet, Prof., M.D.: paediatric urologist, urological counselling, revision Ulrich Willi, Prof., M.D.: paediatric radiologist, radiological counselling Guido F. Laube, PD, M.D.: paediatric nephrologist, nephrological counselling, writting, revision, man in charge.

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Authors and Affiliations

  1. University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland

    Samuel Nef, Giuseppina Spartà, Marcus Weitz, Kathrin Buder, Rita Gobet, Ulrich Willi & Guido F. Laube

  2. Children’s Hospital Lucerne, Lucerne, Switzerland

    Thomas J. Neuhaus

  3. Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland

    Josef Wisser

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  1. Samuel Nef
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  2. Thomas J. Neuhaus
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Correspondence to Samuel Nef.

Ethics declarations

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Written informed consent was obtained from all parents or guardians of each child included in the study.

Additional information

Communicated by Jaan Toelen

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Nef, S., Neuhaus, T.J., Spartà, G. et al. Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract. Eur J Pediatr 175, 667–676 (2016). https://doi.org/10.1007/s00431-015-2687-1

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  • DOI: https://doi.org/10.1007/s00431-015-2687-1

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