In utero Fetal Urine Analysis and Renal Histology Correlate with the Outcome in Fetal Obstructive Uropathies

Abstract

We evaluated 8 second-trimester fetuses who had undergone termination because of obstructive uropathies and correlated the renal histopathology with fetal urine biochemical prognostic parameters. Prenatal evaluation included serial vesicocentesis, karyotyping, and sonography. According to the urinary biochemical parameters, 3 fetuses were classified to be in the good prognostic category, 2 in the borderline prognostic category, and 3 in the poor prognostic category. The kidneys were evaluated both grossly and microscopically for hydronephrosis, pelvicaliceal dilatation, cystic changes and fibrosis. Fetuses in the poor prognostic category had severely damaged renal architecture, microcysts, macrocysts, and extensive fibrosis. Fetuses in the good prognostic category had minimal histopathologic changes with preservation of the architecture. Fetuses in the borderline category showed a moderate degree of renal damage but with focally preserved architecture. We conclude (1) that there is a direct correlation between elevation in urinary electrolytes and proteins and extent of underlying renal histopathological damage and (2) that appropriate detailed prenatal evaluation of the renal function can identify fetuses who could potentially benefit from in utero therapy.

Prenatal Diagnosis of Cloacal Dysgenesis Sequence: Differential Diagnosis from Other Forms of Fetal Obstructive Uropathy

“…These studies differentiate fetuses with a good prognosis from those with a poor prognosis [11] and also help differentiate fetuses with preserved renal histology from those with extensive renal damage [18]. Once a fetus has been determined to have a good or a poor prognosis, appropriate therapeutic procedures can be offered to the parents [11].…”

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 Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

“…A total of 23 articles 5,24,29,39,40,42,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] met the selection criteria. All of the studies were observational studies and of poor quality ( Figure 6).…”