Prenatally diagnosed urinary tract abnormalities: long-term outcome.

Area of Science:

• Pediatric Urology
• Prenatal Diagnosis
• Renal Function

Background:

• Long-term outcomes of prenatally detected uropathies are not well-documented.
• Limited data exist on fetal intervention for prenatal uropathies.
• Prenatal diagnosis of vesicoureteric reflux (VUR) identifies males at risk for renal impairment.

Purpose of the Study:

• To review the long-term outcomes of various prenatal uropathies.
• To evaluate the impact of prenatal diagnosis and intervention on renal function and morbidity.
• To clarify the prognosis for conditions like VUR, pelviureteric junction (PUJ) obstruction, and multicystic dysplastic kidney (MCDK).

Main Methods:

• Literature review of studies on prenatal uropathies and their long-term outcomes.
• Analysis of data on fetal intervention, vesicoureteric reflux (VUR), pelviureteric junction (PUJ) obstruction, and multicystic dysplastic kidney (MCDK).
• Assessment of renal function, mortality, and morbidity associated with these conditions.

Main Results:

• Fetal intervention may reduce early mortality from pulmonary hypoplasia but does not improve long-term renal function.
• High-grade primary vesicoureteric reflux (VUR) in males poses a long-term risk of renal impairment.
• Prenatal diagnosis and intervention have reduced morbidity for pelviureteric junction (PUJ) obstruction, but some early surgeries may be unnecessary.
• Multicystic dysplastic kidney (MCDK) has a low risk of childhood hypertension.
• Mild pelvicaliectasis is generally an innocent finding with no increased morbidity risk.

Conclusions:

• Long-term outcomes for prenatal uropathies are heterogeneous, with varying risks of renal impairment and morbidity.
• While some interventions improve outcomes for conditions like PUJ obstruction, others, like fetal intervention for VUR, show limited long-term benefit.
• Careful monitoring and selective intervention are crucial for managing prenatally detected uropathies to avoid unnecessary procedures.