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

Abstract

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.

Severe Fetal CAKUT (Congenital Anomalies of the Kidneys and Urinary Tract), Prenatal Consultations, and Initiation of Neonatal Dialysis

“…parent dissensus [21][22][23]. Similar to the low frequency of consultations with ethicists in fetal CAKUT prenatal counseling reported in this study, other studies report that despite many hospitals having access to ethics teams, ethical consultations are often underutilized despite a need for ethical guidance and expertise [24].…”

Late Preterm Infant With Postnatal Diagnosis of Renal Tubular Dysgenesis

“…Small, dysplastic, or entirely absent kidneys suggest renal agenesis, whereas large, cystic, hyperechogenic renal masses suggest ARPKD. 17 Obstruction of the urinary tract demonstrates normal/enlarged kidneys with concurrent hydroureter, hydronephrosis, and/or thickened bladder. With congenital RTD, the kidneys appear normal or slightly enlarged with echogenic noncystic parenchymal texture and have abnormal corticomedullary differentiation.…”

Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease

“…The established AF peptide signature provides for the first time an unambiguous prediction of postnatal renal outcome with significantly higher accuracy compared to conventional methods. In addition, the measurement of AF peptides is not subject to personal interpretation, which can be the case for sonographic imaging 5,17,18 . In case a high-risk phenotype is diagnosed, clear-cut knowledge of the outcome of the disease will give time to the future parents to psychologically accept 19 the fact that they will have a child with chronic, potentially severe disease and decide whether they would like their newborn to be offered palliative care or renal replacement therapies (RRT, i.e.…”