Diagnostic accuracy of an interdisciplinary tertiary center evaluation in children referred for suspected congenital anomalies of the kidney and urinary tract on fetal ultrasound - a retrospective outcome analysis

Abstract

Background Fetal ultrasound organ screening has become a standard of care in most high-income countries. This has resulted in increased detection of congenital abnormalities, which may lead to major uncertainty and anxiety in expectant parents, even though many of them are of minor relevance. In order to optimize prenatal counselling, we introduced an interdisciplinary approach for all pregnant women referred to our center by private obstetricians for a co-assessment of suspected relevant fetal abnormalities of the kidney or urinary tract, involving both experienced prenatal ultrasound specialists and a pediatric nephrologist or urologist. Methods In a retrospective analysis, we evaluated reports of intrauterine evaluation and postnatal follow-up in order to assess accuracy of explicit intrauterine diagnoses and outcome of hydronephroses according to their severity in this setting. Results A total of 175 fetuses were examined between 2012 and 2019 and followed postnatally at our Pediatric Nephrology or Urology Department. There was a high concordance (85.9%) between explicit intrauterine and final diagnoses. Resolution rate of hydronephrosis was higher in patients with intrauterine low-grade than high-grade hydronephrosis (61.8% versus 11.9%). An etiological diagnosis was found in 62.5%, 52.0%, and 11.1% of patients with intrauterine bilateral high-grade, unilateral high-grade, and unilateral high-grade with contralateral low-grade hydronephrosis, respectively, but in none of the patients with intrauterine low-grade hydronephrosis. Conclusions The results of our study demonstrate that, through interdisciplinary teamwork, intrauterine assessment of the fetal kidneys and urinary tract is highly accurate and allows a good discrimination between relevant and transient/physiological hydronephroses. Graphical abstract

Surgical approach to the treatment of urinary tract anomalies

“…Važno ih je na vrijeme otkriti kako bi se preveniralo nepovratno oštećenje bubrega, a samim time i razvoj bubrežne insuficijencije. Zbog navedenog prenatalni i postnatalni ultrazvučni probir mokraćnog sustava ima važnu ulogu u ranom otkrivanju ovih anomalija 2,6 . Prenatalni ultrazvučni probir predstavlja veliki izazov u prenatalnoj dijagnostici s visokom stopom detekcije oko 90%, premda je uzrok i vrstu anomalije teže izdi ferencirati 6 .…”

“…Zbog navedenog prenatalni i postnatalni ultrazvučni probir mokraćnog sustava ima važnu ulogu u ranom otkrivanju ovih anomalija 2,6 . Prenatalni ultrazvučni probir predstavlja veliki izazov u prenatalnoj dijagnostici s visokom stopom detekcije oko 90%, premda je uzrok i vrstu anomalije teže izdi ferencirati 6 . Zahvaljujući ranom ultrazvučnom skri ningu veliki dio anomalija mokraćnog sustava se rano otkrije, ali još uvijek postoji manji udio bolesnika u kojih se ove anomalije kasno otkriju i dovedu do zna čajnog oštećenja bubrežnog tkiva.…”

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

“…Although it can be difficult to precisely predict postnatal kidney function from prenatal studies, prior research has identified some predictive features of neonatal kidney function based upon ultrasound and fetal biochemistry. [6][7][8] There are also established staging systems to assist maternal-fetal medicine clinicians and pediatric nephrologists with prenatal counseling and patient selection for in utero interventions. It is unclear if these studies are being used to assist with pediatric nephrology prenatal counseling and this should be explored in future studies.…”

Antenatal hydronephrosis: role of different sonographic approaches in predicting prognosis

“…An attractive question is the best time and kind of imaging workup of the babies. Many neonates with AH have normal postnatal sonography; an imaging study is unnecessary (7). On the other hand, some critical entities, such as severe UPJO, VUR, and posterior urethral valve (PUV), need early diagnosis and treatment to prevent severe complications (8).…”