Fetal Therapy for Renal Anhydramnios

Area of Science:

• Perinatology
• Pediatric Nephrology
• Medical Genetics

Background:

• Congenital anomalies of the kidney and urinary tract (CAKUT) represent a spectrum of developmental abnormalities.
• Severe CAKUT manifesting as renal anhydramnios in fetal life is often lethal due to associated pulmonary hypoplasia.
• Fetal intervention is being explored for select cases, necessitating careful patient stratification.

Purpose of the Study:

• To evaluate the safety and efficacy of fetal therapy for severe CAKUT.
• To assess the role of amnioinfusions in preventing pulmonary hypoplasia.
• To determine appropriate criteria for selecting pregnancies for fetal intervention.

Main Methods:

• The Renal Anhydramnios Fetal Therapy (RAFT) trial is a multi-center study.
• Serial amnioinfusions are administered to restore amniotic fluid volume.
• Detailed anatomic surveys and genetic testing are performed for patient stratification.

Main Results:

• Pulmonary hypoplasia is a primary concern in fetuses with renal anhydramnios.
• Restoration of amniotic fluid is the cornerstone of prenatal treatment.
• Ongoing research aims to establish the efficacy of this therapeutic approach.

Conclusions:

• Fetal intervention, including amnioinfusions, holds potential for managing lethal forms of CAKUT.
• Comprehensive evaluation including genetic testing is crucial for identifying suitable candidates for therapy.
• The RAFT trial will provide critical data on the safety and effectiveness of preventing pulmonary hypoplasia in these high-risk pregnancies.