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Prognostic factors in fetal hydronephrosis: a multivariate analysis
E A Oliveira1, J S Diniz, A C Cabral
1Pediatric Nephrourology Unit, Department of Pediatrics, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. eduolive@medicina.ufmg.br
Insights
Oligohydramnios, prematurity, and low glomerular filtration rate are key predictors of adverse outcomes in fetal hydronephrosis. Early identification and specialized care are crucial for affected newborns.
Area of Science:
- Pediatric Nephrology
- Fetal Medicine
- Neonatal Urology
Background:
- Obstetric echography has increased the detection rate of fetal hydronephrosis.
- Identifying prognostic factors for adverse outcomes in fetal hydronephrosis is critical for appropriate management.
Purpose of the Study:
- To identify prognostic factors associated with adverse outcomes, including renal failure and death, in infants diagnosed with fetal hydronephrosis.
Main Methods:
- Prospective follow-up of 148 children with fetal hydronephrosis.
- Univariate analysis using the Kaplan-Meier method to identify associated variables.
- Multivariate Cox's proportional hazards model to determine independent predictors of adverse outcomes.
Main Results:
- Oligohydramnios, prematurity, and a glomerular filtration rate (GFR) below 20 ml/min were identified as independent predictors of adverse outcomes.
- These factors significantly correlated with increased risk of renal failure and mortality.
Conclusions:
- Oligohydramnios, prematurity, and impaired renal function (GFR < 20 ml/min) are critical indicators for poor prognosis in fetal hydronephrosis.
- Infants presenting with these factors require specialized follow-up and management in centers equipped for neonatal uropathy care.
Abstract:
With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox's model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox's multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns.