Postnatal Management in Congenital Lower Urinary Tract Obstruction With and Without Prenatal Vesicoamniotic Shunt

Jank, Marietta; Stein, Raimund; Younsi, Nina

doi:10.3389/fped.2021.635950

Cited by 6 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study's use of the combined pigtail + double disk device with a 100% functional rate in liveborn infants offers the novel opportunity to investigate nephropathy in boys with severe cLUTO (16). Furthermore, the secure placement of this shunt type provided reliable urinary drainage after birth as well, allowing the stabilization and growth of these small and vulnerable neonates (25).…”

Section: Discussionmentioning

confidence: 99%

Predictors of advanced chronic kidney disease in infancy after definitive vesicoamniotic shunting for congenital lower urinary tract obstruction

et al. 2022

View full text Add to dashboard Cite

BackgroundSevere congenital lower urinary tract obstruction (cLUTO) is associated with poor postnatal outcomes, including chronic and end stage kidney disease, and high mortality. Studies of the impact of fetal intervention through vesicoamniotic shunting are marred by a device malfunction rate of up to 60%. In this study, we delineate the postnatal course and infant kidney function following definitive urinary diversion in utero.Materials and MethodsThis is a retrospective, single-center cohort study of 16 male infants who survived the fetal intervention to birth, from 2010 to 2014 at a single center. All had patent shunts in place at birth. Perinatal and biochemical characteristics were collected with patients followed for one year, or until demise, with serial measures of serum creatinine (SCr) and serum cystatin C (CysC).ResultsOf the 16 males, 81% were non-white (38% black, 43% Hispanic). Shunts were placed at a median of 20 weeks (IQR 19,23) gestation, with median fetal bladder volume of 39 cm3 (IQR 9.9,65). All neonates were born preterm [median 34 weeks (IQR 31,35)] and the majority with low birth weight [median 2340 grams (1,895, 2,600)]. 63% required positive pressure ventilation. Advanced chronic kidney disease stage 4–5 at 1 year of age was predicted by neonatal characteristics: peak SCr ≥2 mg/dl, time to peak SCr > 6 days, discharge SCr ≥1.0 mg/dl, CysC ≥2.5 mg/l, urine protein:creatinine ≥4.8 mg/mg, urine microalbumin:creatinine ≥2.2 mg/mg. In infancy, a nadir SCr ≥0.5 mg/dl occurring before 160 days (5.3 months) of age was also predictive of advanced chronic kidney disease stage 4–5 at 1 year. Three patients died in the neonatal period, with 1 receiving kidney replacement therapy (KRT). Three additional patients required KRT before 12 months of age.ConclusionsEven with definitive vesicoamniotic shunting for cLUTO, postnatal morbidity and mortality remain high, emphasizing the role of renal dysplasia, in spite of urinary diversion, in postnatal kidney dysfunction. Neonatal and infant biochemical parameters exhibit distinct trends that offer families and physicians a better understanding of the prognosis of childhood kidney function.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of advanced chronic kidney disease in infancy after definitive vesicoamniotic shunting for congenital lower urinary tract obstruction

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Nowadays, prenatally diagnosed PUV are still a negative prognostic factor regarding maintaining kidney function. It has been proven that these cases presented the most severe malformations [2,3]. Also, the analysis of long-term outcomes in these children showed that 24-45% developed renal failure in childhood or adolescence [4].…”

Section: Introductionmentioning

confidence: 91%

Short-term postnatal renal outcome after vesico-amniotic shunting in boys with posterior urethral valves diagnosed prenatally

Stańczyk,

Tkaczyk,

Sójka

et al. 2024

polp

View full text Add to dashboard Cite

Introduction:The most common interventions in lower urinary tract obstruction are vesico-amniotic shunting (VAS) and serial amnioinfusions; however, their outcome remains uncertain. The aim of the study was to assess the kidney function as well as clinical complications in boys at the age of 6 months with posterior urethral valves (PUV), who underwent prenatal VAS and survived the neonatal period.Material and methods: The study group consisted of 14 boys and the mean time of the VAS procedure was 22 weeks of gestational age (GA). Children were born in 34 GA (29-39) with average birth weight of 2860 g. Four fetuses needed amnioinfusion. In the study we assessed physical development, prevalence and aetiology of urinary tract infections (UTIs), number of hospitalizations, estimated glomerular filtration rate, presence of hypertension, albuminuria, proteinuria and acidosis.Results: Average body weight at 6 months of life was 7.2 kg. 86% of children had at least one UTI; the same percentage were given antibacterial prophylaxis. 36% underwent urinary diversion. Median number of hospitalizations was 4. One patient required chronic renal replacement therapy, and one needed a short course of peritoneal dialysis. Median serum creatinine level was 0.65 mg/dl with estimated glomerular filtration rate (eGFR) 50.6 ml/min/1.73 m 2 . Average serum cystatin C level was 1.50 mg/l with eGFR 48.5 ml/min/1.73 m 2 . 43% developed acidosis. 71% had elevated albuminuria with a median urine albumin-to-creatinine ratio of 581.64 mg/g. 28.5% had overt proteinuria.Conclusions: Growth at the age of 6 month of infants with PUV after prenatal VAS was barely satisfactory. More than half had impaired kidney function, but the need for renal replacement therapy was uncommon.

show abstract

“…Therefore, it is necessary to monitor fluid status and electrolytes, in order to properly supplement sodium chloride if necessary and to assess kidney function and treat possible urinary tract infections (UTI). Primary valve ablation in the first 4 to 16 weeks of life through transurethral incision (TUI) is the preferred mode of management, along with administering urinary catheter drainage for at least the first 72 h [ 9 ]. The exact time point of TUI is also dependent on the size of the available resectoscope devices.…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management

Klaus

Lange-Sperandio

2022

Biomedicines

View full text Add to dashboard Cite

Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dl implies a very low risk for ESKD, whereas a value above 0.85 mg/dl indicates beneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival.

show abstract

Postnatal Management in Congenital Lower Urinary Tract Obstruction With and Without Prenatal Vesicoamniotic Shunt

Cited by 6 publications

References 24 publications

Predictors of advanced chronic kidney disease in infancy after definitive vesicoamniotic shunting for congenital lower urinary tract obstruction

Predictors of advanced chronic kidney disease in infancy after definitive vesicoamniotic shunting for congenital lower urinary tract obstruction

Short-term postnatal renal outcome after vesico-amniotic shunting in boys with posterior urethral valves diagnosed prenatally

Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management

Contact Info

Product

Resources

About