Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

• Published in: Clinical journal of the American Society of Nephrology Vol. 7; no. 3; pp. 444 - 451
• Main Authors: Quirino, Isabel G, Diniz, Jose Silverio S, Bouzada, Maria Candida F, Pereira, Alamanda K, Lopes, Thais J, Paixão, Gabriela M, Barros, Natalia N, Figueiredo, Luisa C, Cabral, Antonio Carlos V, Simões e Silva, Ana Cristina, Oliveira, Eduardo A
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01-03-2012
• Subjects: Adolescent; Brazil; Child; Child, Preschool; Female; Humans; Hydronephrosis - diagnostic imaging; Hydronephrosis - embryology; Hypertension - etiology; Infant; Infant, Newborn; Kaplan-Meier Estimate; Kidney - abnormalities; Kidney - diagnostic imaging; Kidney - surgery; Kidney Diseases - etiology; Male; Odds Ratio; Original; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Ultrasonography, Prenatal; Urinary Tract - abnormalities; Urinary Tract - diagnostic imaging; Urinary Tract - surgery; Urinary Tract Infections - etiology; Urogenital Abnormalities - complications; Urogenital Abnormalities - diagnostic imaging; Urogenital Abnormalities - embryology; Urogenital Abnormalities - mortality; Urogenital Abnormalities - surgery; Urologic Surgical Procedures; Young Adult
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.03400411

With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.
In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.
Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P<0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P<0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P<0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P<0.001).
In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.