title: Defining and predicting 'intrauterine fetal renal failure' in congenital lower urinary tract obstruction.
abstract: BACKGROUND
  The aim of this study was to identify predictors of 'intrauterine fetal renal failure' in fetuses with severe congenital lower urinary tract obstruction (LUTO).
  
  
  METHODS
  We undertook a retrospective study of 31 consecutive fetuses with a diagnosis of LUTO in a tertiary Fetal Center between April 2013 and April 2015. Predictors of 'intrauterine fetal renal failure' were evaluated in those infants with severe LUTO who had either a primary composite outcome measure of neonatal death in the first 24 h of life due to severe pulmonary hypoplasia or a need for renal replacement therapy within 7 days of life. The following variables were analyzed: fetal bladder re-expansion 48 h after vesicocentesis, fetal renal ultrasound characteristics, fetal urinary indices, and amniotic fluid volume.
  
  
  RESULTS
  Of the 31 fetuses included in the study, eight met the criteria for 'intrauterine fetal renal failure'. All of the latter had composite poor postnatal outcomes based on death within 24 h of life (n = 6) or need for dialysis within 1 week of life (n = 2). The percentage of fetal bladder refilling after vesicocentesis at time of initial evaluation was the only predictor of 'intrauterine fetal renal failure' (cut-off <27 %, area under the time-concentration curve 0.86, 95 % confidence interval 0.68-0.99; p = 0.009).
  
  
  CONCLUSIONS
  We propose the concept of 'intrauterine fetal renal failure' in fetuses with the most severe forms of LUTO. Fetal bladder refilling can be used to reliably predict 'intrauterine fetal renal failure', which is associated with severe pulmonary hypoplasia or the need for dialysis within a few days of life.
authors.affiliation: Department of Obstetrics and Gynecology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA. ruano@bcm.edu.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA. ruano@bcm.edu.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Renal Section, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Safdar
authors.affiliation: Division of Pediatric Urology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Au
authors.affiliation: Division of Pediatric Urology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Division of Pediatric Urology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Patricio
authors.initials: P
authors.lastname: Gargollo
authors.affiliation: Department of Obstetrics and Gynecology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
authors.affiliation: Department of Obstetrics and Gynecology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.affiliation: Department of Pediatric Surgery, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Department of Pediatric Surgery, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.affiliation: Department of Anesthesiology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Olutoyin A
authors.initials: OA
authors.lastname: Olutoye
authors.affiliation: Department of Pediatrics, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Welty
authors.affiliation: Division of Pediatric Urology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Roth
authors.affiliation: Department of Obstetrics and Gynecology, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Renal Section, Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, Houston, TX, USA.|Texas Children's Fetal Center at the Texas Children's Hospital Pavilion for Women-Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Braun
mesh_terms: D000015:Abnormalities, Multiple; D005260:Female; D005315:Fetal Diseases; D017052:Hospital Mortality; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008168:Lung / Q000002:abnormalities; D008171:Lung Diseases / Q000150:complications; D008297:Male; D054238:Perinatal Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016216:Ultrasonography, Prenatal; D014524:Urethral Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D014551:Urinary Tract / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014564:Urogenital Abnormalities / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy
keywords: Fetal lower urinary tract obstruction; Fetal surgery; Posterior urethral valves; Prenatal diagnosis; Renal function; Ultrasonography; Vesicoamniotic shunt