Antenatal oligohydramnios of renal origin: long-term outcome.
BACKGROUND
Prognosis of fetuses with renal oligohydramnios (ROH) is often still regarded as poor. Neonatal complications and the long-term follow-up of fetuses with ROH in two pediatric centres are described. Method. 23 fetuses (16 males, 7 females) were included as patients. Primary diseases included congenital anomalies of the kidney and urinary tract (n = 16), autosomal recessive polycystic kidney disease (n = 4) and renal tubular dysgenesis (n = 3). The analysis includes retrospective chart review.


RESULTS
Seven children died (30%), the majority (n = 4, 17%) within the neonatal period due to pulmonary hypoplasia and renal insufficiency. Fourteen patients (61%) required postnatal mechanical ventilation for a median of 4 (range 1-60) days; 11 infants had an associated pneumothorax. All 16 surviving children have chronic kidney disease (CKD) at a current median age of 5.7 years (range 0.5-14.5), managed conservatively in eight patients [median glomerular filtration rate 51 (range 20-78) ml/min/1.73 m(2)]. Eight patients reached end-stage renal disease at a median age of 0.3 years (range 2 days to 8.3 years), including one patient with pre-emptive kidney transplantation. Five of the patients requiring dialysis underwent successful renal transplantation at a median age of 3.5 years (range 2.5-4). Growth was impaired in seven children requiring growth hormone treatment. Cognitive and motor development was normal in 12 (75%) of the 16 patients and showed a delay in four children, including two with associated syndromal features.


CONCLUSIONS
ROH is not always associated with a poor prognosis and long-term outcome in survivors is encouraging. The high incidence of neonatal complications and long-term morbidity due to CKD requires a multidisciplinary management of these children.
Klaassen
Ilka
I
Pediatric Nephrology, University Medical Center, Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Neuhaus
Thomas J
TJ
Mueller-Wiefel
Dirk E
DE
Kemper
Markus J
MJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000150:complications* / Q000151:congenital / Q000196:embryology; D008297:Male; D016104:Oligohydramnios / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors