title: Sequential fetal serum β2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction.
abstract: OBJECTIVE
  Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome.
  
  
  METHODS
  We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome.
  
  
  RESULTS
  Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant).
  
  
  CONCLUSIONS
  Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.|University Paris Descartes and Sorbonne Paris-Cité, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Spaggiari
authors.affiliation: Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Faure
authors.affiliation: Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dreux
authors.affiliation: Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Czerkiewicz
authors.affiliation: Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.|University Paris Descartes and Sorbonne Paris-Cité, Paris, France.
authors.forename: J J
authors.initials: JJ
authors.lastname: Stirnemann
authors.affiliation: Department of Developmental Biology, Robert Debré Hospital, AP-HP, Paris, France.|University Paris Diderot and Sorbonne Paris-Cité, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Guimiot
authors.affiliation: Department of Pediatric Nephrology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Heidet
authors.affiliation: Department of Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France.
authors.forename: R
authors.initials: R
authors.lastname: Favre
authors.affiliation: Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.|University Paris Descartes and Sorbonne Paris-Cité, Paris, France.
authors.forename: L J
authors.initials: LJ
authors.lastname: Salomon
authors.affiliation: University Paris Diderot and Sorbonne Paris-Cité, Paris, France.|Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Oury
authors.affiliation: Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.|University Paris Descartes and Sorbonne Paris-Cité, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
authors.affiliation: Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France.|University Versailles Saint-Quentin, Versailles, France.
authors.forename: F
authors.initials: F
authors.lastname: Muller
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005315:Fetal Diseases / Q000097:blood / Q000175:diagnosis; D005602:France; D005865:Gestational Age; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000097:blood / Q000175:diagnosis*; D014524:Urethral Obstruction / Q000097:blood / Q000175:diagnosis*; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D001613:beta 2-Microglobulin
keywords: fetal obstructive uropathy; fetal serum β2-microglobulin; posterior urethral valve; renal function