Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies

Area of Science:

• Pediatric Nephrology
• Prenatal Diagnosis
• Urology

Background:

• Congenital obstructive uropathies pose risks to fetal renal function.
• Accurate prenatal assessment is crucial for effective management.
• Predicting long-term renal outcomes in affected fetuses remains a challenge.

Purpose of the Study:

• To evaluate the predictive capability of fetal urinalysis for postnatal renal function in infants with bilateral uropathy.
• To identify specific fetal urine analytes that correlate with renal function at 1-2 years of life.

Main Methods:

• Prospective cohort study of 100 fetuses diagnosed with bilateral uropathy.
• Fetal urine samples analyzed for concentrations of 11 key analytes.
• Correlation of prenatal findings with postnatal serum creatinine levels at 1-2 years.

Main Results:

• Fetal urinary beta-2 microglobulin demonstrated high sensitivity (0.80) and specificity (0.83) for predicting elevated postnatal serum creatinine.
• Fetal urinary sodium, chloride, and urea showed high sensitivity but low specificity.
• Fetal urinary glucose, phosphorus, calcium, ammonium, and total proteins were specific but lacked sensitivity.

Conclusions:

• Fetal urinalysis, particularly beta-2 microglobulin levels, offers a valuable tool for predicting renal function in infants with congenital obstructive uropathies.
• This approach aids in personalized prenatal management, guiding decisions on intrauterine therapy.
• Predicting good spontaneous outcomes can help avoid unnecessary interventions like prenatal uro-amniotic shunting.