Prognostic factors in fetal hydronephrosis: a multivariate analysis

Oliveira, Eduardo A.; Diniz, José Silvério Santos; Cabral, Antônio Carlos Vieira; Leite, Henrique Vítor; Colosimo, Enrico A.; Oliveira, Raquel B. B.; Vilasboas, Aranaí S.

doi:10.1007/s004670050716

Cited by 53 publications

(27 citation statements)

References 28 publications

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“…Postnatally, neonates were investigated according to a systematic protocol described elsewhere [13]. All were placed on prophylactic antibiotics at birth, and prophylaxis was continued in children with urinary tract obstruction until corrective surgery was performed, and in newborns with ureteral reflux until reflux resolved.…”

Section: Methodsmentioning

confidence: 99%

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Oliveira

Diniz²,

Cabral

et al. 2000

Fetal Diagn Ther

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Objective: The purpose of this study was to identify predictive factors of fetal urethral obstruction. Methods: One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol and prospectively followed. Possible predictive factors of urethral obstruction associated with fetal echography and clinical findings on admission were studied. The analysis was conducted in two steps. In a univariate analysis, variables associated with urethral obstruction were identified by the χ² test or by Fisher’s exact test. Then, the variables that were significantly associated with urethral obstruction were included in a multiple logistic regression analysis. Results: After final adjustment by multiple logistic regression analysis, only two variables were identified as independent predictors of fetal urethral obstruction: oligohydramnios (odds ratio, OR = 5, 95% confidence interval, CI, = 1.3–15, p = 0.01) and megacystis (OR = 9, 95% CI = 2.0–40, p = 0.004). The sensitivity and specificity of the combination of both variables were 60 and 98.5%, respectively. Conclusions: The presence of oligohydramnios and megacystis on prenatal ultrasound is highly predictive of fetal urethral obstruction.

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Section: Methodsmentioning

confidence: 99%

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Oliveira

Diniz²,

Cabral

et al. 2000

Fetal Diagn Ther

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“…However, since only 3 of the 24 patients in our study had this maximum expression, it was rather rare. In their multivariate analysis of prenatal fi ndings in 148 fetuses, Oliveira et al [5] only found oligohydramnios and megacystis to be independent predictors of PUV. Abbott et al [6] reported only 8 confi rmations of 19 prenatally suspected PUVs in the presence of megacystis and hydronephrosis.…”

Section: Prenatal Diagnosticsmentioning

confidence: 97%

Posterior Urethral Valves: Prenatal Diagnostic Signs and Outcome

Eckoldt

Woderich²,

Wolke³

2004

Urol Int

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Introduction: Urethral valves can be of enormous clinical importance. Both the prognosis for an affected fetus and the indication for a prenatal therapeutic intervention depend to a high degree on the accuracy of the prenatal diagnosis. Patients and Methods: The sonographic findings and the results of the postnatal diagnostic workup of 24 boys treated for urethral valves in our institute are analyzed in the present paper. Results: Out of a group of 900 children, diagnosed prenatally as having urinary tract anomalies, the postnatal diagnostic workup revealed 24 boys suffering from posterior urethral valves. The combination of megacystis, oligohydramnios, and bilateral renal abnormalities was present in 3 boys, and it was only in these cases that urethral valves were correctly identified as the underlying pathology. The largest group (n = 16) of these fetuses presented with bilateral hydronephrosis with and without megaureter. Megacystis in any combination with other findings was detected only in 4 patients. Oligohydramnios as a sign of impaired renal function was observed in four pregnancies. Four children suffered postnatally from beginning renal insufficiency. Eight infants (33%) required some form of respiratory support. This group included the 4 newborns with oligohydramnios during the pregnancy. Conclusions: Posterior urethral valves represent a rare but severe congenital malformation. They can disrupt the development of the entire urinary tract and may be life-limiting to the affected boy. Only rarely, however, are they manifested as the complete pathological picture on prenatal ultrasound. In most cases, bilateral impairment of the fetal renal development suggests severe subvesical obstruction. Thus in cases with bilateral renal impairment on prenatal ultrasonography, posterior urethral valves are to be excluded postnatally. Oligohydramnios is a predictor of a poor outcome of the renal function.

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“…In the first decade of the study, infants were investigated according to a comprehensive systematic protocol described elsewhere (14)(15)(16). After 2000, we developed a more tailored clinical protocol (17)(18)(19).…”

Section: Study Protocolmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

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Prognostic factors in fetal hydronephrosis: a multivariate analysis

Cited by 53 publications

References 28 publications

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Posterior Urethral Valves: Prenatal Diagnostic Signs and Outcome

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

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