Postnatal transient renal insufficiency in the feto-fetal transfusion syndrome

Christensen, Anders Mark; Daouk, Ghaleb H.; Norling, Laura L.; Catlin, Elizabeth A.; Ingelfinger, Julie R.

doi:10.1007/s004670050575

Cited by 13 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various renal complications have been reported in donor twins in TTTS and include renal cortical necrosis and fibrosis [162], transient renal insufficiency and hematuria [14], acute renal failure requiring long-term peritoneal dialysis [163], or permanent tubular dysfunction with polyuria due to renal tubular dysgenesis [15,164]. Autopsy studies in chronic TTTS report that renal tubular dysgenesis, characterized by loss of proximal convoluted tubules, is found in almost 50% of donor twins [15].…”

Section: Renal Morbiditymentioning

confidence: 99%

“…Severe cerebral damages in the surviving monochorionic twin may even occur during the first trimester [11]. In TTTS with double survival, recipient twins are at risk for lifethreatening cardiovascular complications such as hypertrophic cardiomyopathy and right ventricular outflow tract obstruction [12,13], whereas donor twins are at risk for acute or chronic renal failure due to chronic renal hypoperfusion [14,15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Twin-to-Twin Transfusion Syndrome: From Placental Anastomoses to Long-Term Neurodevelopmental Outcome

Lopriore

Middeldorp²,

Sueters³

et al. 2005

CPR

View full text Add to dashboard Cite

Twin-to-twin transfusion syndrome (TTTS) is a complication of monochorionic twin pregnancies associated with high perinatal mortality and morbidity. Placental vascular anastomoses, almost invariably present in monochorionic placentas, are the essential anatomical substrate for the development of TTTS. According to recent studies, different pathophysiological mechanisms may play a role. Diagnosis of TTTS is no longer based on neonatal criteria such as birth weight discordance and hemoglobin difference, but on strict prenatal ultrasound criteria. A significant evolution in prenatal care strategies and management options for patients with TTTS has occurred during the last decade. Endoscopical laser ablation of communicating placental vessels is a new treatment modality that has led to an increase in survival rates. In perinatology, a decrease in mortality rates may be associated with an increase in morbidity rates. Follow-up studies in infants with TTTS are shedding more light on the wide range of morbidity associated with TTTS, such as neurological, cardiac and renal sequelae. This review analyzes the possible pathophysiological mechanisms involved, discusses the latest findings in diagnosis, therapy and prognosis, and focuses on neonatal and pediatric morbidity associated with TTTS.

show abstract

Section: Renal Morbiditymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Twin-to-Twin Transfusion Syndrome: From Placental Anastomoses to Long-Term Neurodevelopmental Outcome

Lopriore

Middeldorp²,

Sueters³

et al. 2005

CPR

View full text Add to dashboard Cite

show abstract

“…However, even in otherwise healthy fetuses, premature birth can lead to major handicaps, such as cerebral palsy, severe cognitive deficits and severe visual or hearing impairments. Neonates that have suffered from chronic TTTS in utero are known to have an additional risk of neurological morbidity, and renal and cardiovascular complications are characteristic in TTTS pregnancies 5–7 …”

Section: Introductionmentioning

confidence: 99%

Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?

Middeldorp

Lopriore

Sueters

et al. 2007

BJOG

View full text Add to dashboard Cite

Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin-to-twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.Design A retrospective cohort study.Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.Main outcome measures Primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.

show abstract

“…Christensen et al report transient renal insufficiency in one single donor twin whose renal function and growth had normalized by 6 months of age [12]. A study by Cincotta et al [13] compared the perinatal mortality and morbidity of infants with TTTS with matched twin controls without TTTS.…”

Section: Discussionmentioning

confidence: 97%

Long-term outcome of kidney function after twin–twin transfusion syndrome treated by intrauterine laser coagulation

et al. 2005

View full text Add to dashboard Cite

Twin-twin transfusion syndrome (TTTS) is caused by unbalanced shunting of blood between monochorionic twins. It is well known that chronic hypotension and hypovolemia may cause renal insufficiency in the donor twin. The long-term outcome of kidney function after TTTS has not previously been delineated in the literature, however. The aim of this study was to evaluate the long-term outcome of kidney function in children after intrauterine laser treatment for severe TTTS. Eighteen surviving twin pairs after intrauterine laser treatment for TTTS were involved in the study. Their gestational age at birth was 29-39 weeks, their median birth weight was 2050 g, and their median age at evaluation was 3 years 1 month, range 1 year 9 months to 4 years 5 months. Serum creatinine, cystatin C, and beta 2-microglobulin, sodium, potassium, and phosphate excretion, and urine albumin and alpha-1-microglobulin were measured. Creatinine clearance was calculated by use of the Schwartz formula. The laboratory findings for all 36 children were within normal limits. There were no significant differences between donors and recipients. Despite severe alteration of renal function before the laser treatment (anuria-polyuria) no long-term impairment of renal function could be detected in any of the 18 twin pairs.

show abstract

Postnatal transient renal insufficiency in the feto-fetal transfusion syndrome

Cited by 13 publications

References 17 publications

Twin-to-Twin Transfusion Syndrome: From Placental Anastomoses to Long-Term Neurodevelopmental Outcome

Twin-to-Twin Transfusion Syndrome: From Placental Anastomoses to Long-Term Neurodevelopmental Outcome

Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?

Long-term outcome of kidney function after twin–twin transfusion syndrome treated by intrauterine laser coagulation

Contact Info

Product

Resources

About