Biochemical diagnosis in prenatal uropathy

Area of Science:

• Fetal Medicine
• Pediatric Nephrology
• Biochemistry

Background:

• Prenatal diagnosis of fetal anomalies often requires assessing organ function.
• Obstructive uropathy and renal cysts are significant fetal conditions impacting kidney development.
• Intrauterine interventions necessitate accurate evaluation of fetal renal status.

Purpose of the Study:

• To evaluate the utility of fetal fluid aspirate analysis for assessing renal function.
• To differentiate between fetal renal cysts and functional kidneys in cases of obstructive uropathy.
• To establish biochemical markers for guiding obstetric management in affected fetuses.

Main Methods:

• Intrauterine fluid aspiration was performed on 32 fetuses (gestational weeks 15-37).
• Analyzed aspirates for sodium (Na), potassium (K), creatinine, urea, alpha 1-, and beta 2-microglobulin.
• Correlated analyte concentrations with fetal diagnoses: prune-belly syndrome, renal cyst, obstructive uropathy.

Main Results:

• Fetal sodium < 130 mmol/L and creatinine > 115 mumol/L indicated active kidneys, excluding renal cysts.
• Fluid from fetal cysts or obstructive uropathy showed analyte concentrations similar to fetal extracellular fluid (ECF).
• Biochemical markers effectively distinguished between functional and non-functional renal conditions.

Conclusions:

• Fetal fluid aspiration analysis, particularly for sodium and creatinine, is a valuable tool.
• This method aids in assessing remaining renal function in fetuses with cystic abdominal cavities.
• Results inform obstetric management strategies for pregnancies with suspected fetal renal abnormalities.