Premium
Fetal urine biochemistry at 13–23 weeks of gestation in lower urinary tract obstruction: criteria for in‐utero treatment
Author(s) -
Abdennadher W.,
Chalouhi G.,
Dreux S.,
Rosenblatt J.,
Favre R.,
Guimiot F.,
Salomon L. J.,
Oury J. F.,
Ville Y.,
Muller F.
Publication year - 2015
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.14734
Subject(s) - medicine , urinary tract obstruction , fetus , urinary system , in utero , urine , gestation , renal function , endocrinology , urology , kidney , gastroenterology , pregnancy , biology , genetics
Objectives To assess the value of fetal urine biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction ( LUTO ) to refine prognosis and to select potential candidates for in‐utero intervention. Methods This was a retrospective study including 72 cases of LUTO with fetal urine sampled before 23 weeks and assayed for total protein, β‐2‐microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma‐glutamyl transpeptidase ( GGTP ). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. Results LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU /L vs 5 IU /L; P < 0.0001) were observed in fetal urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β‐2‐microglobulin ( P = 0.0017), sodium ( P = 0.0008), chloride ( P = 0.0028) and calcium ( P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β‐2‐microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. Conclusions Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal urine biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal urine biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.