Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin

Grijseels, E. W. M.; van-Hornstra, Ptm Echteld; Govaerts, L.; Cohen–Overbeek, Titia E.; Krijger, Ronald R. de; Smit, Bert; Cransberg, Karlien

doi:10.1002/pd.2827

Cited by 33 publications

(33 citation statements)

References 19 publications

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“…In total, 45% (37% TOP, 8% palliative care) of the counseled families opted primarily against continuation of the pregnancy or postnatal sustained medical treatment. This rate is comparable to that reported in other studies where only TOP was reported and chosen in 46-58% of the cases [16,17].…”

Section: The Third Way: Palliative Caresupporting

confidence: 78%

“…Under these conditions mortality, mostly due to pulmonary hypoplasia, ranges from 30 to 50% and up to 75% (Table 1) [9,[11][12][13][14][15][16][17][18]. However, the high variation in mortality between studies is dependent on the decision regarding TOP and the co-morbidities of liveborn children, both factors which could be misleading in the interpretation of data (Table 1).…”

Section: Introductionmentioning

confidence: 99%

“…Of note, in the group with renal agenesis or kidney hypo-/dysplasia the diagnosis of ROH was made earlier than in the groups with ARPKD and obstructive uropathy, and the diagnosis of ROH was associated with the worst survival (30%) in liveborn and actively treated children. Thus, the decision for TOP in this cohort seems to be based on known risk factors, such as onset of ROH and associated malformations [11,13,14,16,17]. However, the association of onset of ROH and outcome in liveborn children in general is debatable.…”

Section: Introductionmentioning

confidence: 99%

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Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome

Loos

Kemper

2017

Pediatr Nephrol

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The presence of renal oligohydramnios (ROH) in a fetus has been associated in the past with a poor prognosis for survival, although recent studies have shown that survival has improved considerably due to the advances in neonatology and pediatric nephrology. In an article recently published in Pediatric Nephrology, evaluation of a large series by Mehler and colleagues confirms the improved prognosis, showing a survival rate of 32 of 38 (84%). In addition, only 12 of 35 (34%) neonates required renal replacement therapy. In five of these 12 children the dialysis could be terminated after the neonatal period. This study has important implications on the decision-making process and counseling of families. While 37% of families of the study opted for termination of pregnancies, palliative care was chosen by 8% of the families, representing an important option when a decision cannot be made rapidly by affected families. A multidisciplinary approach is not only necessary in the active treatment of neonates with a history of ROH but also in antenatal counseling. In this regard future efforts should establish consensus on an ethical framework for the decision-making process in ROH.

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Section: The Third Way: Palliative Caresupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome

Loos

Kemper

2017

Pediatr Nephrol

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“…They reported that of 25 liveborn neonates with different antenatal ultrasound findings, nine children (3 with dysplasia, 4 with polycystic kidneys and 2 with hydronephrosis) were not resuscitated because of the associated malformations, and treatment was withheld in an additional seven patients because of the suspected malformations. This study also included patients with very low birth weight, which might have had an impact on morbidity and mortality [43]. Studies which selectively examine fetuses with LUTO are limited by incomplete clinical data despite the probable inclusion of patients with ROH; for example, in a series of 15 patients with urethral valves, five of the patients died [44].…”

Section: Treatment Options (Ante-and Postnatal)mentioning

confidence: 99%

“…In other studies, survivors of ROH are not actively treated, thus increasing mortality. For example, Grijseels et al [43] conducted a retrospective case series in which they analysed the outcome of 71 pregnancies complicated by ROH. They reported that of 25 liveborn neonates with different antenatal ultrasound findings, nine children (3 with dysplasia, 4 with polycystic kidneys and 2 with hydronephrosis) were not resuscitated because of the associated malformations, and treatment was withheld in an additional seven patients because of the suspected malformations.…”

Section: Treatment Options (Ante-and Postnatal)mentioning

confidence: 99%

Severe antenatally diagnosed renal disorders: background, prognosis and practical approach

Aulbert

Kemper

2015

Pediatr Nephrol

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Perinatal Diagnosis, Management, and Follow-up of Cystic Renal Diseases

et al. 2018

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IMPORTANCEPrenatal and neonatal cystic kidney diseases are a group of rare disorders manifesting as single, multiple unilateral, or bilateral cysts or with increased echogenicity of the renal cortex without macroscopic cysts. They may be accompanied by grossly enlarged kidneys, renal oligohydramnios, pulmonary hypoplasia, extrarenal abnormalities, and neonatal kidney failure. The prognosis is extremely variable from trivial to very severe or even uniformly fatal, which poses significant challenges to prenatal counseling and management.OBJECTIVE To provide a clinical practice recommendation for fetal medicine specialists, obstetricians, neonatologists, pediatric nephrologists, pediatricians, and human geneticists by aggregating current evidence and consensus expert opinion on current management of cystic nephropathies before and after birth.METHODS After 8 systematic literature reviews on clinically relevant questions were prepared (including 90 studies up to mid-2016), recommendations were formulated and formally graded at a consensus meeting that included experts from all relevant specialties. After further discussion, the final version was voted on by all members using the Delphi method. The recommendations were reviewed and endorsed by the working groups on inherited renal disorders of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and European Society for Paediatric Nephrology (ESPN); the German Society of Obstetrics and Gynecology (DGGG), German Society of Perinatal Medicine (DGPM), and German Society of Ultrasound in Medicine (DEGUM); and the alliance of patient organizations, PKD International. RECOMMENDATIONSThe group makes a number of recommendations on prenatal and postnatal imaging by ultrasound and magnetic resonance imaging, genetic testing, prenatal counseling, in utero therapeutic interventions, and postnatal management of prenatal and neonatal cystic kidney diseases, including provision of renal replacement therapy in neonates. In addition to detailed knowledge about possible etiologies and their prognosis, physicians need to be aware of recent improvements and remaining challenges of childhood chronic kidney disease, neonatal renal replacement therapy, and intensive pulmonary care to manage these cases and to empower parents for informed decision making.

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Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin

Abstract: The prognosis of early onset renal oligohydramnios is poor. Predictive determinants of survival are: GA at diagnosis, nature of renal anomaly (hydronephrosis vs other), and presence of associated anomalies.

Cited by 33 publications

References 19 publications

Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome

Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome

Severe antenatally diagnosed renal disorders: background, prognosis and practical approach

Perinatal Diagnosis, Management, and Follow-up of Cystic Renal Diseases

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