A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves

Abstract

Background-Posterior urethral valves (PUV) accounts for 17% of pediatric renal failure. The management of pregnancies involving fetuses with PUV is hampered by the fact that current clinical parameters obtained from fetal ultrasound and/or fetal urine biochemistry are insufficient to predict postnatal renal function. We previously have developed a fetal urine peptide signature (12PUV) that predicted with high precision postnatal renal failure at 2 years of age in fetuses with PUV. Here we evaluated the accuracy of this signature to predict postnatal renal outcome in fetuses with PUV in an independent single center study. Methods-Thirty three woman carrying fetuses with suspected PUV were included. Twenty five fetuses received vesicoamniotic shunts (VAS) during pregnancy. PUV was confirmed postnatally in 23 patients. Of those 23 fetuses, 2 were lost in follow-up. Four and 3 patients died in the pre-and perinatal-period, respectively. Follow-up renal function at 6 month of age was obtained for the remaining 14 patients. The primary outcome was early renal failure, defined by an eGFR<60 mL/min/1.73 before 6 months of age or pre-or perinatal death. Results-The peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 (95%CI: 0.74-1.0) and an accuracy of 90% (95%CI: 78-100). The signature predicted postnatal renal outcome for the suspected PUV cases with an AUC of 0.89 (95%CI: 0.72-0.97) and an accuracy of 84% (95%CI: 71-97). Conclusion-This single center study confirms the predictive power of the previously identified 12PUV fetal urinary peptide signature.

Comparison of the amniotic fluid and fetal urine peptidome for biomarker discovery in renal developmental disease

“…We identified and validated 12 peptides in fetal urine (FU) that predicted in utero postnatal renal survival in fetuses with developmental renal disease ( i.e. posterior urethral valves, PUV) 10 , 11 . However, in contrast to postnatal urine, sampling of FU is invasive since it is collected directly from the fetal bladder.…”

Value of Urine Peptides in Assessing Kidney and Cardiovascular Disease

“…The validity of the 12 fetal urine peptides in predicting postnatal renal outcome alone was recently verified in a single center study. [ 62 ] In this study the peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 and an in the suspected PUV cases with an AUC of 0.89. This small‐scale single center study is therefore an important premise for the recently started prospective large‐scale study, named ANTENATAL (clinicaltrials.gov NCT03116217; “multicentre vAlidatioN of a fetal urine pepTidome‐based classifiEr to predict postnatal reNAl function in posterior ureThral vALves”), aiming to validate the 12PUV signature in a much larger multicenter setting.…”

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

“…The fetal imaging details, from the detailed ultrasound ± MRI technology, provide understanding for the extent of renal morbidity, but can create clinical variance secondary to the expertise in the LUTO diagnostic and prognostic interpretation (Table 1) [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”