Lower urinary tract obstruction: fetal intervention based on prenatal staging

Springer Science and Business Media LLC - Tập 32 - Trang 1871-1878 - 2017
Rodrigo Ruano1, Timothy Dunn2, Michael C. Braun2, Joseph R. Angelo2, Adnan Safdar2
1Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, Rochester, USA
2Renal Section, Baylor College of Medicine and Texas Children’s Fetal Center – Texas Children’s Hospital Pavilion for Women, Houston, USA

Tóm tắt

The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18 weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30 weeks; prenatal surveillance is recommended. Stage II LUTO is characterized by oligohydramnios/anhydramnios, hyperechogenic kidneys but absent renal cortical cysts or apparent signs of renal dysplasia and favorable fetal urinary biochemistry; fetal vesicoamniotic shunting (VAS) or fetal cystoscopy is indicated to prevent pulmonary hypoplasia and renal failure. Stage III LUTO is oligohydramnios/anhydramnios, hyperechogenic kidneys with cortical cysts and renal dysplasia and unfavorable fetal urinary biochemistry after serial evaluation; fetal vesicoamniotic shunt may prevent severe pulmonary hypoplasia but not renal failure. Stage IV is characterized by intrauterine fetal renal failure, defined by anhydramnios and ultrasound (US) findings suggestive of severe renal dysplasia, and is associated with death in 24 h of life or end-stage renal disease (ESRD) within the first week of life; fetal vesicoamniotic shunt and fetal cystoscopy are not indicated.

Tài liệu tham khảo

Anumba DO, Scott JE, Plant ND, Robson SC (2005) Diagnosis and outcome of fetal lower urinary tract obstruction in the northern region of England. Prenat Diagn 25:7–13 Malin G, Tonks AM, Morris RK, Gardosi J, Kilby MD (2012) Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG 119:1455–1464 Morris RK, Ruano R, Kilby MD (2011) Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review. Ultrasound Obstet Gynecol 37:629–637 Sananes N, Cruz-Martinez R, Favre R, Ordorica-Flores R, Moog R, Zaloszy A, Giron AM, Ruano R (2016) Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn 36:297–303 Morris RK, Kilby MD (2011) Long-term renal and neurodevelopmental outcome in infants with LUTO, with and without fetal intervention. Early Hum Dev 87:607–610 Ruano R, Safdar A, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Belfort MA, Braun MC (2016) Defining and predicting ‘intrauterine fetal renal failure’ in congenital lower urinary tract obstruction. Pediatr Nephrol 31:605–612 Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Safdar A, Moaddab A, Meyer N, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Braun MC, Belfort MA (2015) Fetal lower urinary tract obstruction—a proposal of standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol 48:476–482 Tonni G, Vito I, Ventura A, Grisolia G, De Felice C (2013) Fetal lower urinary tract obstruction and its management. Arch Gynecol Obstet 287:187–194 Tonni G, Ida V, Alessandro V, Bonasoni MP (2013) Prune-belly syndrome: case series and review of the literature regarding early prenatal diagnosis, epidemiology, genetic factors, treatment, and prognosis. Fetal Pediatr Pathol 31:13–24 Wu S, Johnson MP (2009) Fetal lower urinary tract obstruction. Clin Perinatol 36:377–390 Clayton DB, Brock JW 3rd (2014) Lower urinary tract obstruction in the fetus and neonate. Clin Perinatol 41:643–659 Kilbride HW, Yeast J, Thibeault DW (1996) Defining limits of survival: lethal pulmonary hypoplasia after midtrimester premature rupture of membranes. Am J Obstet Gynecol 175:675–681 Freedman AL, Johnson MP, Smith CA, Gonzalez R, Evans MI (1999) Long-term outcome in children after antenatal intervention for obstructive uropathies. Lancet 354:374–377 Vanderheyden T, Kumar S, Fisk NM (2003) Fetal renal impairment. Semin Neonatol 8:279–289 Arant BS Jr (1978) Developmental patterns of renal functional maturation compared in the human neonate. J Pediatr 92:705–712 Cobet G, Gummelt T, Bollmann R, Tennstedt C, Brux B (1996) Assessment of serum levels of alpha-1-microglobulin, beta-2-microglobulin, and retinol binding protein in the fetal blood. A method for prenatal evaluation of renal function. Prenat Diagn 16:299–305 Muller F, Dommergues M, Bussieres L, Lortat-Jacob S, Loirat C, Oury JF, Aigrain Y, Niaudet P, Aegerter P, Dumez Y (1996) Development of human renal function: reference intervals for 10 biochemical markers in fetal urine. Clin Chem 42:1855–1860 Lumbers ER, Hill KJ, Bennett VJ (1988) Proximal and distal tubular activity in chronically catheterized fetal sheep compared with the adult. Can J Physiol Pharmacol 66:697–702 Shimada K, Matsumoto F, Tohda A, Ueda M (2003) Histological study of fetal kidney with urethral obstruction and vesicoureteral reflux: a consideration on the etiology of congenital reflux nephropathy. Int J Urol 10:518–524 Woolf AS, Thiruchelvam N (2001) Congenital obstructive uropathy: its origin and contribution to end-stage renal disease in children. Adv Ren Replace Ther 8:157–163 Nagata M, Shibata S, Shu Y (2002) Pathogenesis of dysplastic kidney associated with urinary tract obstruction in utero. Nephrol Dial Transplant 17(Suppl 9):37–38 Attar R, Quinn F, Winyard PJ, Mouriquand PD, Foxall P, Hanson MA, Woolf AS (1998) Short-term urinary flow impairment deregulates PAX2 and PCNA expression and cell survival in fetal sheep kidneys. Am J Pathol 152:1225–1235 Oliveira EA, Diniz JS, Cabral AC, Pereira AK, Leite HV, Colosimo EA, Vilasboas AS (2000) Predictive factors of fetal urethral obstruction: a multivariate analysis. Fetal Diagn Ther 15:180–186 Bernardes LS, Aksnes G, Saada J, Masse V, Elie C, Dumez Y, Lortat-Jacob SL, Benachi A (2009) Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol 34:419–423 Robyr R, Benachi A, Daikha-Dahmane F, Martinovich J, Dumez Y, Ville Y (2005) Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol 25:478–482 Bernardes LS, Salomon R, Aksnes G, Lortat-Jacob S, Benachi A (2011) Ultrasound evaluation of prognosis in fetuses with posterior urethral valves. J Pediatr Surg 46:1412–1418 Morris RK, Malin GL, Khan KS, Kilby MD (2009) Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG 116:1290–1299 Pico H, Dabadie A, Bourliere-Najean B, Philip N, Capelle M, Aschero A, Quarello E, Guys JM, Hery G, Petit P, Gorincour G (2014) Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies. Diagn Interv Imaging 95:573–578 Alamo L, Laswad T, Schnyder P, Meuli R, Vial Y, Osterheld MC, Gudinchet F (2010) Fetal MRI as complement to US in the diagnosis and characterization of anomalies of the genito-urinary tract. Eur J Radiol 76:258–264 Savelli S, Di Maurizio M, Perrone A, Tesei J, Francioso A, Angeletti M, La Barbera L, Ballesio L, de Felice C, Porfiri LM, Manganaro L (2007) MRI with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) assessment in the evaluation of normal and abnormal fetal kidneys: preliminary experience. Prenat Diagn 27:1104–1111 Quintero RA, Johnson MP, Romero R, Smith C, Arias F, Guevara-Zuloaga F, Cotton DB, Evans MI (1995) In-utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy. Lancet 346:537–540 Martinez JM, Masoller N, Devlieger R, Passchyn E, Gomez O, Rodo J, Deprest JA, Gratacos E (2015) Laser ablation of posterior urethral valves by fetal cystoscopy. Fetal Diagn Ther 37:267–273 Ruano R (2011) Fetal surgery for severe lower urinary tract obstruction. Prenat Diagn 31:667–674 Glick PL, Harrison MR, Golbus MS, Adzick NS, Filly RA, Callen PW, Mahony BS, Anderson RL, deLorimier AA (1985) Management of the fetus with congenital hydronephrosis II: prognostic criteria and selection for treatment. J Pediatr Surg 20:376–387 Morris RK, Middleton LJ, Malin GL, Quinlan-Jones E, Daniels J, Khan KS, Deeks J, Kilby MD, PLUTO Collaborative Group (2015) Outcome in fetal lower urinary tract obstruction: a prospective registry study. Ultrasound Obstet Gynecol 46:424–431 Nicolini U, Spelzini F (2001) Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn 21:964–969 Eugene M, Muller F, Dommergues M, Le Moyec L, Dumez Y (1994) Evaluation of postnatal renal function in fetuses with bilateral obstructive uropathies by proton nuclear magnetic resonance spectroscopy. Am J Obstet Gynecol 170:595–602 Morris RK, Quinlan-Jones E, Kilby MD, Khan KS (2007) Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn 27:900–911 Nicolaides KH, Cheng HH, Snijders RJ, Moniz CF (1992) Fetal urine biochemistry in the assessment of obstructive uropathy. Am J Obstet Gynecol 166:932–937 Nicolini U, Fisk NM, Rodeck CH, Beacham J (1992) Fetal urine biochemistry: an index of renal maturation and dysfunction. Br J Obstet Gynaecol 99:46–50 Muller F, Dommergues M, Mandelbrot L, Aubry MC, Nihoul-Fekete C, Dumez Y (1993) Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies. Obstet Gynecol 82:813–820 Lipitz S, Ryan G, Samuell C, Haeusler MC, Robson SC, Dhillon HK, Nicolini U, Rodeck CH (1993) Fetal urine analysis for the assessment of renal function in obstructive uropathy. Am J Obstet Gynecol 168:174–179 Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann JJ, Guimiot F, Heidet L, Favre R, Salomon LJ, Oury JF, Ville Y, Muller F (2016) Sequential fetal serum beta2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. Ultrasound Obstet Gynecol. doi:10.1002/uog.15968 Johnson MP, Corsi P, Bradfield W, Hume RF, Smith C, Flake AW, Qureshi F, Evans MI (1995) Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy. Am J Obstet Gynecol 173:59–65 Ruano R, Sananes N, Sangi-Haghpeykar H, Hernandez-Ruano S, Moog R, Becmeur F, Zaloszyc A, Giron AM, Morin B, Favre R (2015) Fetal intervention for severe lower urinary tract obstruction: a multicenter case–control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol 45:452–458 Haeri S, Simon DH, Pillutla K (2017) Serial amnioinfusions for fetal pulmonary palliation in fetuses with renal failure. J Matern Fetal Neonatal Med 30:174–176 Bienstock JL, Birsner ML, Coleman F, Hueppchen NA (2014) Successful in utero intervention for bilateral renal agenesis. Obstet Gynecol 124:413–415 Tranquilli AL, Giannubilo SR, Bezzeccheri V, Scagnoli C (2005) Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial. BJOG 112:759–763 Kozinszky Z, Pasztor N, Vanya M, Sikovanyecz J, Pal A (2013) Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option? J Matern Fetal Neonatal Med 26:383–387 Trnka P, Hiatt MJ, Tarantal AF, Matsell DG (2012) Congenital urinary tract obstruction: defining markers of developmental kidney injury. Pediatr Res 72:446–454