ESPN 51th Annual Meeting

ESPN 2018


 
Short-term outcome in boys with prenatal intervention for posterior urethral valves
MARCIN TKACZYK 1 MAłGORZATA STAńCZYK 1 WALDEMAR KRZESZOWSKI 1 JUSTYNA WOJTERA 1 IWONA MAROSZYńSKA 1 TOMASZ TALAR 1 BARBARA PAWłOWSKA 1 DARIUSZ OLEJNICZAK 1 MICHAł PODGóRSKI 1 ALINA NIEWIADOMSKA 1 RAFAł ŚWIECHOWSKI 1 KRZYSZTOF SZAFLIK 1

1- POLISH MOTHERS MEMORIAL HOSPITAL RESEARCH INSITUTE
 
Introduction:

There is a controversy whether the prenatal intervention is able to prevent kidney injury in prenatally detected posterior urethral valves (PUV) or it is of no profit. The only randomised control trial (PLUTO) finished without definite conclusion. There is no agreement on decision which biochemical or clinical marker has any predictive value for postnatal kidney function. We aimed the study to assess the survival rate and early renal outcome in PUV fetuses with prenatal vesico-amniotic shunting (VAS).


Material and methods:

 The study group consisted of 33 fetuses with PUV from singleton pregnancies (1-4 pregnancy). The procedures of intervention and follow-up were  performed according to the local standards. 28 fetuses later obtained at least 1 VAS. Artificial amniotic fluid was introduced in 15/33 pregnances.

Results:

 20 fetuses (60%)  survived until delivery with mean APGAR score of 8. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis for 3-19 days, but at 30th day all children were dialysis-free. Renal function was compromised in 14/17 of subjects with mean eGFR on 4th day 18,3 (5-48) ml/min/1.73m2;  11/17 had significant acidosis and proteinuria (mean: 103; r:25-338 mg/dl).  10 boys required ventilation support for 1-20 days. Mean ICU hospitalization time was 54 days (r:3-150). After one month proteinuria persisted in 4/17 boys (mean: 83; r:25-188 mg/d). 1 month survival rate of boys with PUV with prenatal interventions was 17/33 – 51%. The study was granted by Polish Mothers Memorial Hospital Reserach Institute - internal grant 2016/IV/54-GW

Conclusions:

 Prenatal interventions for posterior urethral valves have significant percentage of unfavourable outcome of the pregnancy and immediately after birth (49%). The preservation of normal kidney function in neonates within first days of life is almost impossible to achieve. However, the need of early dialysis is relatively low.