Fetal urine biochemistry in the assessment of obstructive uropathy

Potential for correction of fetal obstructive uropathy: time for a randomized, controlled trial?

“…For this reason diagnostic, and often serial, vesicocentesis has been advocated in an attempt to more accurately predict both the long‐term prognosis and potential prospective candidates for in‐utero vesico‐amniotic shunting12. It appears that serial measurements of urinary sodium, osmolality and β 2 ‐microglobulin (taken in context with the ultrasound appearance) may help in the stratification of prognosis13–15, although not all studies have demonstrated such high sensitivity and specificity of evaluation16.…”

Ultrasound evaluation of prognosis in fetuses with posterior urethral valves

“…Furthermore, if intrauterine procedures such as vesicoamniotic shunts are considered, the evaluation of renal function may help to adequately select patients eligible for the procedure [11]. Several ultrasound parameters have been proposed as predictors of long-term renal function, such as amniotic fluid index and renal parenchyma evaluation [6,8,[12][13][14][15][16][17][18][19][20][21][22]. However, previous studies have been inconclusive concerning the optimal ultrasound parameters for predicting long-term renal function.…”

The effects of overcoming experimental bladder outflow obstruction in fetal sheep

“…Urine from the bladders of fetuses with bladder outflow obstruction showed a significantly greater osmolality than samples from controls (233 vs. 139 mOsmol/l, p < 0.001) 26,27 . The virtual absence of urine in the bladders of those lambs that had undergone surgical decompression rendered measurements impossible in this group.…”

“…This recovery was manifest by a trend towards normal renal lengths, weights and glomerular counts, and a decrease in the amount of cystic change. We decided not to sample urine at periodic intervals under ultrasound guidance to assess changes in renal function, because of the potential to introduce infection and cause pregnancy loss 26,35 . Also, the virtual absence of urine in the bladders of those lambs that had undergone surgical decompression rendered urine measurements at the delivery of these fetuses impossible.…”