Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction: criteria for<i>in-utero</i>treatment

Abdennadher, W.; Chalouhi, G. E.; Dreux, Sophie; Rosenblatt, Jonathan; Favre, R.; Guimiot, Fabien; Salomon, Laurent; Oury, Jean‐François; Ville, Y.; Müller, Françoise

doi:10.1002/uog.14734

Cited by 49 publications

(40 citation statements)

References 29 publications

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“…However, a question arises which is better: expectant approach at the expense of progressively deteriorating renal function [21], or early intervention with a high likelihood of normal renal function in the future. While the answer seems obvious from subjective parental perspective, also our objective findings seem to favour the early intervention since all survivors present with normal renal function at the age of 5-6 years.…”

Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy. Material and methods:Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO.The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed. Results:In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5-6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed. Conclusions:Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

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Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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“…It has been suggested that biochemical analysis of fetal urine could provide valuable insights into prognosis for renal function, but there is no consensus regarding the best test or combination of tests. While good correlation has been observed between fetal serum β2M and postnatal serum creatinine after 24 weeks, fetal blood sampling is difficult to perform before 20 weeks [20,21].…”

Section: Discussionmentioning

confidence: 99%

Excessively High Urinary Beta 2-Microglobulin Level: A Sign of Pathology or Laboratory Error ?

Altas¹,

Akan²,

Çağlıyan³

2018

JPP

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Measurement of urinary β2M (beta 2-microglobulin) is a sensitive and reliable assay for detecting tubular injury, renal toxicity, lymphomas, leukemia, or myeloma. Some chemical substrates may increase the level of β2M in-vivo. Elevated β2M level in urine is unusual because it rapidly degrades when pH is below 6. The level of β2M in the bladder can also be used as a marker to assess renal tubular maturation in neonates. β2M in the bladder could be a result of fetal megacystis, which is an abnormally enlarged bladder appearing after 10 weeks of gestation, when the fetus begins to produce urine. Identification of the pregnant women instead of the fetus is a common pre-analytical error with samples sent from the gynecology clinic to the laboratory. Here we present the case of a 24-year-old pregnant woman whose urine analysis results indicated excessively high β2M level in the urine. The present study could improve the understanding of urinary β2M analysis, laboratory errors, and the interpretation of test results.

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“…Sodium levels in urine above 100 mmol/L have been found to indicate a condition threatening fetal life (usually either renal or pulmonary failure). 13,27 Beta 2-microglobulin is freely filtered by the normal fetal glomeruli and nearly in 100% reabsorbed in the proximal tubules, thus it can be useful as an indicator of fetal glomerular filtration rate (GFR). It also has a predictive value as to postnatal GFR.…”

Section: Assessment Of Fetal Renal Functionmentioning

confidence: 99%

“…Beta 2-microglobulin detected in the urine suggests an impairment in renal tubules function. 13,20,27 Other prognostic factors in fetal urine analysis, such as its specific gravity, osmolality, and the excreted volume have been defined by Glick et al 28 Tests assessing the beta 2-microglobulin in fetal urine and N-acetyl-beta-D-glucosaminidase (NAG) concentration in serum have been recently used to evaluate the degree of damage of renal parenchyma (their concentration is proportional to the extent of damage). The concentration of beta 2-microglobulin above 4 mg/L and cystatin C levels above 1 mg/L, and the NAG levels above 6 mg/dL are thought to be poor prognostic factors for postnatal renal function.…”

Section: Assessment Of Fetal Renal Functionmentioning

confidence: 99%

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Valve bladder syndrome in children: On the trail of the best strategies to prevent chronic kidney disease

Polak−Jonkisz¹,

Rehan²,

Fornalczyk³

et al. 2017

Adv Clin Exp Med

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Pediatric patients suffering from valve bladder syndrome (VBS) are at risk of developing chronic kidney disease (CKD) and renal failure in later life. Therefore, it is of vital importance to determine the risk factors and the best possible strategies for diagnosis and treatment in patients with VBS that would minimize the risk of developing CKD. In this review we have presented the current knowledge of CKD risk factors in patients with posterior urethal value (PUV). We have also discussed possible recommendations for prenatal diagnostics procedures to be undertaken in patients with PUV, postnatal monitoring and therapeutic strategies that could reduce the risk of developing CKD in this population. Although in most cases there are no clear guidelines for appropriate clinical actions that can be undertaken in patients with PUV to minimize the risk of kidney failure, we have tried to present concise and accurate advice for physicians taking care of patients with PUV.

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Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction: criteria forin-uterotreatment

Abstract: Objectives

Cited by 49 publications

References 29 publications

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Excessively High Urinary Beta 2-Microglobulin Level: A Sign of Pathology or Laboratory Error ?

Valve bladder syndrome in children: On the trail of the best strategies to prevent chronic kidney disease

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