Congenital renal tract anomalies: outcome and follow‐up of 402 cases detected antenatally between 1986 and 2001

• Published in: Ultrasound in obstetrics & gynecology Vol. 25; no. 2; pp. 134 - 143
• Main Authors: Damen‐Elias, H. A. M., De Jong, T. P. V. M., Stigter, R. H., Visser, G. H. A., Stoutenbeek, P. H.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2005; Wiley
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Counseling; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - mortality; Follow-Up Studies; follow‐up; Gynecology. Andrology. Obstetrics; Humans; Infant; Kidney Diseases - congenital; Kidney Diseases - diagnostic imaging; Kidney Diseases - mortality; Male; Medical sciences; postnatal outcome; prenatal diagnosis; Prognosis; renal tract; ultrasonography; Ultrasonography, Prenatal - methods; Ultrasonography, Prenatal - mortality; Sonography; Kidney disease; Urinary system disease; Prognosis; Congenital; Surveillance; Malformation; Gynecology; Echography; Obstetrics
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.1788

Objective To determine the long‐term prognosis of antenatally detected renal tract anomalies in order to optimize parental counseling. Methods This was a follow‐up study of all renal tract abnormalities detected antenatally in a Level 3 ultrasound department between 1986 and 2001. Follow‐up data (median age, 8 years) were retrieved from the records of the Paediatric Urology Department or the attending pediatrician. Results A urinary tract anomaly was detected in 408 fetuses. There were four false‐positive diagnoses. From two children follow‐up data were incomplete, leaving 402 cases for analysis. A chromosomal abnormality was present in 7/81 (8.6%) fetuses that had karyotyping. Termination of pregnancy was performed in 55 (13.7%) cases and a further 66 (16.4%) children died during the perinatal period and up to 1 year of age. In 106/121 (26.4% of all fetuses) deceased children the cause of death was directly related to the renal tract anomaly. In the 281 surviving children a total of 545 renal tract anomalies were diagnosed postnatally, requiring a total of 381 surgical interventions in 156 infants. Outcome in survivors was generally good, with impaired renal function in nine infants and hypertension in three (4% of the survivors). Conclusions Congenital renal tract anomalies are associated with a high mortality rate, especially when they are structural developmental anomalies of the kidneys. Survivors require multiple operations, but the outcome is generally favorable. Ultrasound diagnosis, especially when made early, of non‐lethal urinary tract anomalies may prevent additional renal damage by timing of delivery and early postnatal treatment. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.