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Severe fetal hydronephrosis: the added value of associated congenital anomalies of the kidneys and urinary tract (CAKUT) in the prediction of postnatal outcome.

Abstract Objective

To focus on fetuses diagnosed with severe hydronephrosis and correlate pre‐natal sonographic characteristics with post‐natal outcome.

Methods

Cases presenting prenatally with severe hydronephrosis (APRPD) >15 mm) were collected retrospectively over a period of 11 years and divided into two groups: (1) isolated hydronephrosis and (2) those associated with congenital anomalies of the kidney and urinary tract (CAKUT).

Results

83 fetuses comprised the study group: 35 fetuses had isolated severe hydronephrosis and 48 had associated CAKUT. The mean APRPD was 22.6±8.5mm (range 15.0‐66.0 mm).

The CAKUT group was associated with a significantly increased incidence of postnatal need for surgery (17.6% vs. 44.2%. p=0.014), dysplastic kidney (0%vs.14%. P=0.023), and total abnormal outcome (52.9% vs. 86%. p=0.001) in comparison to isolated severe prenatal hydronephrosis.

Conclusions

Severe fetal hydronephrosis has a wide postnatal clinical spectrum which is mainly influenced by the presence of associated sonographic CAKUT findings. This clinical data has biological relevance: a genetic or environmental defect that influences multiple renal developmental processes leads to hydronephrosis but also to concomitant malformations (CAKUT) and critically influences renal prognosis. A more selective abnormal developmental process that results in isolated enlarged pelvis even to a severe extent has less influence on renal prognosis.

Autoren:   Sharon Perlman, Lucia Roitman, Danny Lotan, Zvi Kivilevitch, Benjamin Dekel, Naomi Pode‐Shakked, Ben Pode‐Shakked, Reuven Achiron, Yinon Gilboa
Journal:   Prenatal Diagnosis
Jahrgang:   2018
Seiten:   n/a
DOI:   10.1002/pd.5206
Erscheinungsdatum:   05.01.2018
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