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JOURNAL ARTICLE

Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in the second trimester of pregnancy: a single center experience

Ahmed A Nassr, Alireza A Shamshirsaz, Hadi Erfani, Jimmy Espinoza, Magdalena Sanz Cortes, Chester J Koh, David R Roth, Joseph R Angelo, George T Mandy, Michael C Braun, Rodrigo Ruano, Michael A Belfort
Ultrasound in Obstetrics & Gynecology 2019 April 11
30977189

OBJECTIVE: Congenital lower urinary tract obstruction (LUTO) is a rare condition with high perinatal mortality and morbidity when associated with severe oligohydramnios or anhydramnios in the second trimester of pregnancy. Severe pulmonary hypoplasia and end-stage renal disease are the underlying causes of poor neonatal outcomes in these cases. However, little is known about the subset of fetal LUTO with a normal amount of amniotic fluid at mid-gestation. The objectives of the current study were to describe the natural history, underlying causes, survival and postnatal renal function outcomes of LUTO with normal amniotic fluid volume during the second trimester of pregnancy.

METHODS: We conducted a retrospective study of all cases with fetal LUTO and normal amniotic fluid volume who received prenatal and postnatal care at our quaternary care institution between 2013 and 2017. Data on demographic characteristics, fetal interventions, perinatal survival, need for neonatal respiratory support, postnatal renal function and need for dialysis at the age of 1 and 24 months were analyzed.

RESULTS: Of the 18 fetuses who met our study criteria, 17 (94.4%) survived the perinatal period. Only 2 (11.1%) neonates required respiratory support due to pulmonary hypoplasia. At the age of 2 years, two children (14.3%) had normal renal function, 8 children (57.1%) developed some degree of chronic renal disease (CKD, chronic kidney disease stages 1-4) and 4 children (28.6%) developed end-stage renal disease (ESRD) including two neonates who already manifested ESRD in the neonatal period.

CONCLUSIONS: Most fetuses prenatally diagnosed with LUTO and a normal volume of amniotic fluid at mid-gestation will have a favorable outcome in terms of perinatal survival and few will need long-term respiratory support. However, these children are still at increased risk for chronic renal disease, end-stage renal disease and need for renal replacement therapy. Larger multicenter studies are needed to characterize the prenatal factors associated with postnatal renal function, and to investigate the role of fetal intervention in that group of fetuses who present with late-onset oligohydramnios and evidence of preserved fetal renal function. This article is protected by copyright. All rights reserved.

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