title: Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.
abstract: Congenital anomalies of the kidney and urinary tract are common findings on fetal ultrasound. The aim of this prospective observational study was to describe outcome and risk factors in 115 patients born 1995-2001. All prenatally diagnosed children were stratified into low- and high-risk group and followed postnatally clinically and by imaging at defined endpoints. Risk factors were evaluated using odds ratios. Neonatal diagnosis included pelvi-ureteric junction obstruction (n = 33), vesicoureteral reflux (n = 27), solitary mild pelvic dilatation (postnatal anteroposterior diameter 5-10 mm; n = 25), and further diagnosis as primary obstructive megaureter, unilateral multicystic dysplastic kidney, renal dysplasia and posterior urethral valves. In 38 children with prenatal isolated hydronephrosis, ultrasound normalized at median age of 1.2 years (range 0.1-9). Surgery was performed in 34 children at median age of 0.4 years (0.1-10.8). Persistent renal anomalies without surgery were present in 43 children and followed in 36 for median time of 16 years (12.2-18). Oligohydramnios and postnatal bilateral anomalies were significantly associated with surgery and impaired renal function.
  
  
  CONCLUSIONS
  The majority of children had a favourable postnatal outcome, in particular children with prenatally low risk, i.e. isolated uni- or bilateral hydronephrosis. Oligohydramnios and postnatal bilateral anomalies were risk factors for non-favourable outcome.
  
  
  BACKGROUND
  • In congenital anomalies of the kidney and urinary tract significantly poorer outcome is known in patients with bilateral renal hypoplasia or solitary kidney associated with posterior urethral valves. • Other factors as proteinuria and vesicoureteral reflux were associated with a higher risk of progression to chronic renal failure in these patients. What is New: • Unlike other studies giving us above-mentioned information, we included all patients with any kind of prenatally diagnosed congenital anomalies of the kidney and urinary tract. Our study shows long-term follow up (median 16 years, range 12.2-18 years), especially in patients not needing surgery, but with persistent anomalies. • During postnatal long-term follow up (median 2.2 years, range 0.1-18 years) one third each showed normalization, need of surgery or persistence of anomalies without need of surgery. Our study revealed a good prognosis in the majority of these children, in particular with prenatally low risk, i.e. isolated uni- or bilateral hydronephrosis, and revealed oligohydramnios and postnatal bilateral anomalies as risk factors for a non-favourable outcome, defined as need of surgery, persistent anomalies with impaired renal function, end stage renal failure or death.
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. samuel.nef@gmx.ch.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nef
authors.affiliation: Children's Hospital Lucerne, Lucerne, Switzerland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Neuhaus
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Spartà
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Marcus
authors.initials: M
authors.lastname: Weitz
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Buder
authors.affiliation: Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Josef
authors.initials: J
authors.lastname: Wisser
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Rita
authors.initials: R
authors.lastname: Gobet
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Willi
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Guido F
authors.initials: GF
authors.lastname: Laube
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities* / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000151:congenital / Q000175:diagnosis*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D016216:Ultrasonography, Prenatal / Q000379:methods; D014551:Urinary Tract / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014567:Urography / Q000379:methods; D014570:Urologic Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis*
keywords: Congenital anomalies of the kidney and urinary tract (CAKUT); Outcome; Postnatal; Prenatal; Risk factors