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Amniotic fluid index and fetal bladder outlet obstruction. Do we really need more?
Antonio Zaccara1, Claudio Giorlandino, Luisa Mobili
1Department of Nephrology and Urology, Bambino Gesu' Children's Hospital, Rome, Italy. zaccara@opbg.net
The Journal of Urology
|September 9, 2005
Summary
Amniotic fluid index is a reliable, inexpensive predictor of fetal kidney function in cases of bilateral obstructive uropathy. Normal amniotic fluid levels generally indicate normal long-term renal function in these infants.
Area of Science:
- Perinatology
- Pediatric Nephrology
- Fetal Medicine
Background:
- Prenatal diagnosis advances necessitate early counseling for bilateral obstructive uropathy.
- New biochemical markers for fetal renal function are invasive and not widely available.
- Amniotic fluid assessment, reflecting fetal urination, has been underutilized for renal function evaluation.
Purpose of the Study:
- To evaluate the predictive value of amniotic fluid index for fetal renal function in bilateral obstructive uropathy.
- To compare amniotic fluid volume with postnatal renal function outcomes.
Main Methods:
- A 3-year study of 28 fetuses with bilateral obstructive uropathy.
- Ultrasonographic assessment of amniotic fluid index (AFI) at 17-20 weeks gestation.
- Postnatal evaluation of renal function up to age 1 year, defining impaired function as serum creatinine > 1.2 mg/dl.
Main Results:
- 18 cases had oligohydramnios (low AFI), 10 had normal AFI.
- Oligohydramnios group (9 survivors) showed impaired renal function (mean creatinine 1.3 +/- 0.2 mg/dl).
- Normal AFI group (all survivors) showed normal renal function (mean creatinine 0.6 +/- 0.1 mg/dl).
Conclusions:
- Amniotic fluid index is a reproducible, inexpensive method to predict renal function in bilateral obstructive uropathy.
- Oligohydramnios predicts impaired renal function, while normal AFI predicts normal long-term renal function.
- This information should be promptly communicated to prospective parents.