Fetal urine biochemistry: an index of renal maturation and dysfunction.
OBJECTIVE
To construct a reference range for fetal urinary sodium, potassium, urea, creatinine, calcium and phosphate with gestation and to assess to what extent these biochemical indices are modified in fetuses with lower urinary tract obstruction.


METHODS
Prospective descriptive study.


METHODS
Royal Postgraduate Medical School London.


METHODS
24 women between 17 and 35 weeks gestation with an ultrasound diagnosis of fetal lower urinary tract obstruction, with or without renal dysplasia and a control group of 26 women between 16 and 33 weeks gestation with normal amniotic fluid volume and fetal anatomy.


METHODS
Fetal urine samples (1-100 ml) were aspirated from the control fetuses either before termination of pregnancy (n = 9) or at the time of intrauterine transfusion for Rh alloimmunization (n = 17). The fetuses with obstructive uropathy had urine samples aspirated on one occasion (n = 14) or serially (n = 10).


METHODS
Relation between urine biochemistry and renal damage ascertained clinically or at postmortem.


RESULTS
In the control group, urinary sodium and phosphate decreased and creatinine increased significantly with gestational age, consistent with increasing fetal glomerular filtration rate and progressive maturation of tubular function. Urinary sodium and calcium were significantly higher in fetuses with renal dysplasia compared with those with lower urinary tract obstruction but normal renal histology or normal clinical outcome. Serial urinary samples from fetuses with obstructive uropathy showed more pronounced deviation from the normal with increasing gestation in all fetuses with renal dysplasia. The highest sensitivity in the detection of renal dysplasia was shown by urinary calcium (100%) whereas urinary sodium showed the best specificity (80%).


CONCLUSIONS
Renal damage is the direct effect of urinary obstruction, rather than an association so that treatment should start as soon as possible. Urinary biochemistry may be helpful in the management of these patients.
Nicolini
U
U
Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London.
Fisk
N M
NM
Rodeck
C H
CH
Beacham
J
J
D004573:Electrolytes / Q000652:urine*; D005314:Embryonic and Fetal Development; D005260:Female; D005315:Fetal Diseases / Q000652:urine*; D005865:Gestational Age; D006801:Humans; D007668:Kidney / Q000196:embryology; D011247:Pregnancy; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D014524:Urethral Obstruction / Q000652:urine*
D004573:Electrolytes