Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β‐2‐microglobulin

Spaggiari, Emmanuel; Dreux, Sophie; Czerkiewicz, Isabelle; Favre, R.; Schmitz, Thomas; Guimiot, Fabien; Delmas, Hélène Laurichesse; Verspyck, É.; Oury, Jean‐François; Ville, Y.; Müller, Françoise

doi:10.1002/uog.12328

Cited by 16 publications

(15 citation statements)

References 22 publications

(22 reference statements)

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“…This may explain the discrepancy in the information supplied by serum and urine values. Spaggiari et al also observed an absence of correlation between high levels of β2-microglobulin in urinary ascites and serum, suggesting that the tubular resorption and catabolism are exceeded [11] The increase we observed in β2-microglobulin levels reflected nephron destruction and a reduction in their number [2,6]. This damage to the renal parenchyma results from the reflux and stagnation of urine in the tract [1].…”

Section: Discussioncontrasting

confidence: 43%

“…This discrepancy may reflect the time required to reach a degree of parenchymal injury that will induce an irreversible impairment of kidney function. But because a foetal biopsy is an invasive antenatal procedure and does not indicate the status of the whole renal parenchyma (where lesions may be distributed irregularly), measuring β2-microglobulin levels in the serum appears to constitute the optimum compromise because it will closely reflect the degree of renal histological injury and can provide information on the patient's renal function [11].…”

Section: Gamentioning

confidence: 99%

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Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney

Luton

Delezoide

Leguy

et al. 2013

Clinical Biochemistry

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Section: Discussioncontrasting

confidence: 43%

Section: Gamentioning

confidence: 99%

Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney

Luton

Delezoide

Leguy

et al. 2013

Clinical Biochemistry

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“…En el caso de las uropatías obstructivas fetales existen posibilidades terapéuticas precoces. Su aplicación depende de una adecuada evaluación de la función renal y de la determinación del pronóstico evolutivo con base en la búsqueda de signos ecográficos indirectos y en el análisis bioquímico de la orina fetal incluyendo la valoración de marcadores fetales, en especial la determinación de la beta 2 microglobulina [15][16] .…”

Section: Discussionunclassified

“…Se puede estudiar la función renal fetal por análisis bioquímicos seriados de la orina fetal obtenida por aspiración vesical. Los estudios clínicos han demostrado que la ecografía, la medición de electrolitos urinarios, y muy especialmente los valores de beta 2 microglobulina son buenos predictores de la función renal fetal 16,17 .…”

Section: Discussionunclassified

Variación de la beta-2 microglobulina en orina fetal en punciones sucesivas previo a derivación vesicoamniótica antenatal

Guevara¹

2017

Investigación Materno Perinatal

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Antecedentes y objetivos. La uropatía obstructiva fetal puede ser tratada precozmente mediante la colocación de derivaciónvesicoamniótica intrauterina. Los criterios de tratamiento incluyen la ausencia de malformaciones mayores asociadas, cariotiponormal y función renal conservada demostrada por beta-2 microglobulina < 4 mg/dl. Por la capacidad de concentración deorina en la vejiga fetal, si en una primera punción el valor de beta 2 microglobulina es superior al punto de corte se requiereuna segunda punción a las 48-72 horas para verificar el valor en orina nueva, no concentrada que correspondería al valorreal. El objetivo de investigación es determinar el comportamiento de la variación de los niveles de beta 2 microglobulina, en2 muestras seriadas de orina fetal con intervalo de 48 - 72 horas, en fetos con diagnóstico de uropatía obstructiva referidao alCentro Médico Docente La Trinidad, para establecer la posibilidad de omisión de la segunda punción en caso de encontrarseun patrón específico de comportamiento de la disminución de los valores. Métodos. Se realizó un estudio clínico unicéntrico,descriptivo y longitudinal, incluyendo a 15 embarazadas cuyos fetos fueron diagnosticados con uropatía obstructiva y sincromosopatías, practicándoseles vesicocentesis seriada (48 a 72 horas) para biometría urinaria.

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“…Overall, it is accepted that those with normal karyotype, lack of other congenital anomalies, and pre-senting with oligohydramnios or anhydramnios and favorable urinary biochemistry would be considered good candidates [13]. Fetal intervention is predominantly aimed at restoration of amniotic fluid volume for prevention of pulmonary hypoplasia and urinary decompression for attenuation of ongoing renal damage [14][15][16][17][18]. Treatment options for this subset of fetuses include vesicoamniotic shunting (VAS) which is most commonly used, valve ablation via cystoscopy, and vesicostomy [3].…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental Outcome in Infants with Lower Urinary Tract Obstruction Based on Different Degrees of Severity

et al. 2020

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Objective: To determine postnatal neurodevelopmental (ND) outcomes for children with congenital lower urinary tract obstruction (LUTO) based on disease severity. Methods: Twenty male infants with LUTO were classified prenatally as Stage 1 (normal amniotic fluid and renal function; n = 5), Stage 2 (signs of obstruction with preserved renal function; n = 13), and Stage 3 (signs of severe renal damage; n = 2). ND status was assessed using the Developmental Profile-3 test in 5 developmental domains (physical, adaptive behavior, social-emotional, cognitive, and communication). Each domain was considered to be delayed if standard scores were 2 or more SD below the mean. ND outcomes were compared between cases with an expected normal re-nal function (LUTO Stage 1) and those with impaired renal function (LUTO Stages 2 and 3). Results from cases with Stage 2 were also compared to those from Stage 3. ORs were calculated to predict risk for adverse ND outcome for each domain considering prenatal and postnatal factors. Results: Gestational age (GA) at the diagnosis of LUTO was similar between both groups (Stage 1: 24.85 ± 7.87 vs. Stages 2 and 3: 21.4 ± 4.31 weeks; p = 0.24). Twelve of 15 cases with Stage 2 or 3 underwent vesicoamniotic shunt placement compared to none of Stage 1 fetuses (p < 0.01). No differences in GA at delivery were detected between the groups (37.9 ± 1.6 vs. 35.1 ± 3.6 weeks; p = 0.1). One of the infants in the Stage 2 and 3 groups received a kidney transplant during followup. One case (20%) from Stage 1 group required dialysis during the first 6 months of life, and 1 case from Stage 2 to 3 group required it during the first 6 months (p = 1.0), whereas 3 additional cases needed dialysis from 6 to 24 months (p = 0.6). Mean age at Developmental Profile 3 (DP-3) testing was 20.3 ± 12.3 months (Stage 1: 11.2 ± 8.6 vs. Stages 2 and 3: 23.4 ± 13.4 months; p = 0.07). Fifteen of the 20 patients (75%) had Monteiro et al.

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Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β‐2‐microglobulin

Abstract: Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.

Cited by 16 publications

References 22 publications

Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney

Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney

Variación de la beta-2 microglobulina en orina fetal en punciones sucesivas previo a derivación vesicoamniótica antenatal

Neurodevelopmental Outcome in Infants with Lower Urinary Tract Obstruction Based on Different Degrees of Severity

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