Kidney impairment in fetal growth restriction: three‐dimensional evaluation of volume and vascularization

Abstract

Objectives: Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. Methods: In a retrospective cohort, TRV and renal vascularization of growthrestricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. Results: Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. Conclusion: The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.

Overexpression of microRNAs miR-25-3p, miR-185-5p and miR-132-3p in Late Onset Fetal Growth Restriction, Validation of Results and Study of the Biochemical Pathways Involved

“…The influence of a suboptimal environment during the fetal period produces epigenetic changes that induce short- and long-term gene expression patterns [ 35 , 36 ] favoring, in many cases, susceptibility to certain chronic (metabolic, neurological, renal and cardiovascular) diseases [ 37 , 38 , 39 , 40 ]. This study attempts to clarify underlying epigenetic changes occurring in fetuses with late growth restriction and to highlight the importance of identifying fetuses at increased risk of APO.…”

“…This is reflected in the “brain sparing” phenomenon, in which the fetus redistributes the cardiac output to maximize oxygen and nutrient supply to the brain, with a decrease in the pulsatility index of the middle cerebral artery (MCA) (cerebral vasodilation) [ 42 ]. If the hypoxic condition persists, redistribution of blood flow can lead to altered structure and function of the vasculature, predisposing the fetus to late-onset diseases such as atherosclerosis, systemic hypertension, neurodegenerative diseases and chronic kidney disease [ 37 , 38 , 39 , 40 ] with major repercussions in adult life. The presence of this phenomenon in growth restricted fetuses is associated with smaller head circumferences and brain volumes at birth, and with later neurocognitive anomalies, resulting in poor learning and low academic results [ 43 ].…”

A Review on Deep-Learning Algorithms for Fetal Ultrasound-Image Analysis

“…Poor kidney development is known to be associated with increased risk of kidney disease into adulthood. At the same time, abnormal fetal growth is associated to a reduced functionality of kidneys after birth [121], [122]. In this field, the work in [102] proposes a 3D U-Net to perform kidney segmentation from 3D B-mode and Power Doppler volumes.…”

Multi-Parametric Fusion of 3D Power Doppler Ultrasound for Fetal Kidney Segmentation Using Fully Convolutional Neural Networks

“…3D power Doppler (PD) US has shown reduced renal vascularity in a cohort of cases (n = 23) with urinary dilatation compared to controls (n = 73) [4]. Using B-Mode alone, renal volume has also been shown to correlate with birth weight and be a predictor of fetal growth restriction [5]. However, to calculate these volumetric measures require offline tools that need manual intervention, which given the additional time required, means they are unlikely to be adopted under current clinical workflows, irrespective of their potential utility.…”