Severe congenital anomalies of the kidney and urinary tract: epidemiology can inform ethical decision-making

Abstract

Over half of pregnancies complicated by severe CAKUT ended in termination or stillbirth, but one-third of live-born infants survived to 12 months and the majority of non-survivors died within hours. This may allay concerns about prolonged and futile intensive care for parents considering a trial of therapy.

Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease

“…The different antenatal CAKUT etiologies included in our study are similar to the CAKUT populations encountered in other but retrospective studies 5,16 , suggesting that the signature will be applicable to CAKUT in general. We believe that the excellent prognostic performance of the signature will be maintained with wider application.…”

“…Sixty out of 140 (43%) CAKUT pregnancies were terminated. This rate is slightly lower than in previous European studies where the rate of pregnancy termination was 55-62 7,[22][23][24] , but close to a recent retrospective study from the US (45% (32/71)) 16 . Rarely put in the open, and as also observed in our study, a number of CAKUT pregnancies are terminated while subsequent fetopathology analysis reveals fetal kidneys with normal appearance 9 .…”

A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract

“…Antenatal hydronephrosis (ANH) is one of the most common birth defects and is a surrogate marker of potential congenital renal anomalies (1, 2). Congenital anomalies of the kidney and urinary tract (CAKUT) comprise a wide phenotypic spectrum and are important causes of kidney morbidity and the most frequent cause of chronic kidney disease (CKD) and end-stage renal disease in infants and young children (3–5).…”

Zika Virus Linked Microcephaly and other Neurological Anomalies Epidemic on Neonatal-Perinatal Medicine: Perspective

“…The evidence-based causal relationship between Zika virus and microcephaly and other brain anomalies public health and economic impact calls for an urgent need to establish contextual and effective local and global neonatal-perinatal and postnatal longitudinal surveillance-response system policies and interventions implementation [1][2][3][11][12][13][14][15][16]. Enhancing robust laboratory data and information and analysis findings to appropriately define Zika viral infection syndrome pre, during and post pregnancy.…”

“…Strengthening Zika routine health system surveillance-response systems and research programs/projects is critical in prevention and control of pregnancy outcomes in prone settings and territories [6,9,10]. In addition, elucidating Aedes and sexual transmission related Zika virus transmission ecological, adaptation and human health threat and complications requires coordinated approach to data sharing, surveillance and research is needed in defining the full spectrum of congenital Zika virus syndrome and issues on maternal-child health [11][12][13]. Innovative approaches in Zika vaccines and therapeutic targets discovery and development should be explored coupled with in silico phylogenetics and phylogeography modelling in understanding its evidence about Zika virus infection congenital abnormalities public health threats [14,15].…”