Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction

Area of Science:

• Biomarkers in Neonatal and Pediatric Nephrology
• Fetal Medicine and Prenatal Diagnosis
• Genitourinary Tract Development and Disease

Background:

• Congenital lower urinary tract obstruction (CLUT0) is linked to poor perinatal outcomes and chronic kidney disease (CKD).
• Accurate prognostication is challenging, impacting family counseling and decisions regarding prenatal interventions.
• Identifying reliable biomarkers is crucial for predicting long-term kidney function in affected neonates.

Purpose of the Study:

• To review current evidence on conventional and novel biomarkers for predicting CKD in CLUT0.
• To categorize clinical predictors identified antenatally and postnatally, considering both anatomic and chemical markers.
• To evaluate the prognostic value and challenges associated with obtaining these biomarkers, especially prenatal ones.

Main Methods:

• Systematic review of literature on biomarkers for CLUT0 and CKD prediction.
• Categorization of predictors into antenatal/postnatal and anatomic/chemical.
• Assessment of prognostic value and feasibility of biomarker acquisition, including fetal risks.

Main Results:

• Serum creatinine in infancy is a consistent postnatal chemical biomarker for future kidney function.
• Beta-2 microglobulin may offer early fetal glomerular and tubular function insights, predicting long-term serum creatinine.
• Renal parenchymal area serves as an anatomic surrogate for nephron mass, applicable both prenatally and postnatally.

Conclusions:

• Understanding anatomic and chemical biomarkers is essential for refining staging algorithms in CLUT0.
• Improved biomarker identification can aid in selecting candidates for early in utero intervention.
• Accurate prediction of CKD in CLUT0 is vital for improved patient management and outcomes.