Single center prospective antenatal evaluation of fetal renal and urinary tract disorders and perinatal outcomes

• Bijoya Kabiraj Mukherjee,  
• Sumitra Bachani,*  
• Suchandana Dasgupta

Abstract

Background: Renal disorders are quite common in the fetus which can be picked up antenatally. Early diagnosis can help in early postnatal intervention resulting in better prognosis of these babies. There are only a few studies in Indian scenario for which we choose to highlight the aspects of fetal renal disorders and their postnatal outcomes. Objective: To evaluate fetal renal and urinary tract disorders and study their perinatal outcome. Study design: It is a single centre based prospective observational study. Antenatal women with singleton pregnancy with diagnosed fetal renal and urinary tract disorders were recruited after an informed consent following Institutional Ethical clearance. Ultrasonographic evaluation was performed along with genetic counselling of all the couples. Relevant non-invasive (serum biomarkers, Non Invasive Prenatal Screen) and invasive (amniocentesis) tests were conducted. Fetuses were periodically assessed and post-natal neonates were followed up at 1 week, 3rd month and 6th month of age. Results: Total study population comprised of 60 women including 56% multigravida. There were 21 fetuses with UTD A1 and 16 fetuses with UTD A2/3, 10 fetuses had multicystic kidney and 5 fetuses had bilateral echogenic enlarged kidneys which included 2 cases of Autosomal Recessive Polycystic Kidney Disease (ARPKD). Few other fetuses included 3 cases of bladder outlet obstruction (BOO), 3 cases of isolated unilateral renal agenesis and 2 cases of ectopic kidney. Amongst these, 12 (20%) fetuses had anhydramnios, 11(18.3%) fetuses had associated systemic anomalies and 8 fetuses (13.3%) had associated ultrasonographic soft tissue markers. After appropriate information, education and counselling 19 women underwent serum screening (which revealed low risk for Trisomy screening) and 10 women underwent amniocentesis all of which had normal QFPCR report. Vesicocentesis was performed in one fetus with BOO which showed higher than normal limits for urine osmolality, chloride, sodium, beta-2 microglobulin, total protein and calcium. Medical termination of pregnancy (under gamut of PCPNDT) was opted by ten women, amongst them only two consented for fetal autopsy. All other women delivered at term,50 neonates were live born amongst which 10 had neonatal death. Amongst live neonates, two underwent surgical intervention in neonatal period (1 ureterostomy done for BOO but baby expired after1 week of surgery, 1 pyeloplasty for unresolved UTD P3 after which there had been resolution of the condition and baby is alive). Conclusion: UTD A1 has good prognosis while UTD A2/3 has poor resolution and may need surgical intervention postnatally. Bladder outlet obstruction, multicystic kidney disease, and enlarged echogenic kidneys are predictors of poor survival outcome while isolated single renal agenesis and ectopic kidney have good postnatal outcome. Genetic counselling, appropriate prenatal tests, fetal autopsy, neonatal surveillance and appropriate interventions are essential for diagnosis and improving the perinatal outcome.

Keywords

: Fetal, renal, ultrasound, antenatal, urinary tract, perinatal, prognosis, genetic counselling, amniocentesis, anhydramnios