Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy

Abstract

Background Congenital urinary tract obstruction can lead to perinatal mortality and morbidity. Assessing antenatal ultrasound features may help identify fetuses likely to suffer complications.Objective To evaluate the accuracy of antenatal ultrasound in the prediction of postnatal renal function in cases of congenital lower urinary tract obstruction (LUTO). Data collection and analysis Data were extracted on study characteristics, quality and results to construct 2 · 2 tables.Likelihood ratios for positive (LR+) and negative (LR)) test results, sensitivity and specificity were generated for the different ultrasound parameters and reference standards.Main results Thirteen articles that met the selection criteria, including 215 women and 33 2 · 2 tables. Meta-analysis was performed using clinically similar subgroups to minimise clinical heterogeneity. The ultrasound parameter that showed the best predictive value for postnatal renal function in survivors was renal cortical appearance, sensitivity 0.57 (95% CI 0.37-0.76) and specificity 0.84 (95% CI 0.71-0.94), area under the curve 0.78.Conclusion Measurement of amniotic fluid volume and the appearance of the renal cortex at diagnosis of LUTO show promising predictive accuracy for poor postnatal renal function.

The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

“…The high costs incurred were almost entirely due to prolonged NICU admission immediately after birth in these infants (data not shown). It is possible that these infants would have succumbed to LUTO in the absence of VAS (the infants with 'poor prognosis' on antenatal scans 70 ). These children continued to have higher admission rates in the first year (beyond the neonatal period) and are responsible for the higher costs in the VAS arm relative to the conservative arm.…”

“…This is in all likelihood because evaluation of this diagnostic test has indicated that it has little value over assessment of renal appearance and liquor volume. 14,70 It was also interesting to note the number of antenatally identified babies with LUTO who were potentially amenable to 'in utero' therapy. Of the prenatally suspected, isolated, singleton male LUTO cases, 2% underwent serial vesicocentesis and 8% underwent VAS.…”

“…70 We searched MEDLINE keywords (e.g. enlarged bladder, congenital urinary tract obstruction, posterior urethral valves) for disease.…”

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

“…These factors may have an important impact for prenatal counseling. However, postnatal kidney function is difficult to predict based on ultrasound studies, especially the long-term outcome [4,5]. Magnetic resonance imaging scans can provide additional information on fetal urinary tract abnormalities in some cases, but these have not been evaluated as a modality to predict postnatal outcome [6,7].…”

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

“…In one study of fetal hyperechogenic kidneys (mostly due to ARPKD), the presence of ROH and a kidney size of >4 standard deviations (SD) had a negative impact on outcome [17]. Morris et al [18] performed a systematic review that included 215 pregnancies with ultrasound evidence of congenital LUTO in which they evaluated the accuracy of fetal ultrasound to predict postnatal renal function. Any described ultrasound parameter was considered in the analysis (i.e.…”