ESPN 51th Annual Meeting

ESPN 2018


 
Is there a chance for complete wellbeing and normal kidney function after prenatal intervention for posterior urthral valves ? – 6 months outcome.
MAłGORZATA STAńCZYK 1 MARCIN TKACZYK 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 ADRIAN KRYGIER 1 KRZYSZTOF SZAFLIK 1

1- POLISH MOTHERS MEMORIAL HOSPITAL RESEACH INSTITUTE, LODZ, POLAND
 
Introduction:

 

Although there is a technical possibility for prenatal intervention in suspicion of posterior urethral valves (PUV) its good effect is uncertain. If only the child will survive there is no guarantee for him and caregivers to lead the perfectly normal life. The aim of the study was to assess the kidney function and clinical complications at the age of 6 months in boys with PUV  who underwent prenatal vesico-amniotic shunting (VAS).

 

 

 

 

Material and methods:

The study group consisted of 12 boys aged 6 months who lived out of 33 fetuses included in the study. Mean time of VAS was 22 hbd (13-30).  Children were born in 34 week of pregnancy (29-39) with mean birth weight 2860g (1850-4440g). 4 fetuses needed amnioinfusion. In 6 month we assessed  physical development, recurrent urinary tract infections (RUTI), number of hospitalizations, need to antibacterial prophylaxis, presence of hypertension, eGFR based on creatine level, presence of albuminuria, proteinuria and acidosis.

 

 

Results:

Mean body weight in 6 month of life was 7.4kg (5.8 -9.8). Children increased their birth weight by 2.7 times (1.5-3.62). Only one child had elevated blood pressure. 50% had RUTI but 91% were treated with antibacterial prophylaxis.  50% needed vesicostomy. Mean number of hospitalizations was 3 (0-9). None was on chronic renal replacement therapy although one needed short course of peritoneal dialysis in newborn period. Mean serum creatinine level was 0.89mg/dl (0.2-2.7), with eGFR (Schwartz formula) 55.68ml/min/1.73m2 (9.67 – 130.1) – 42% had normal eGFR for age. 50% had elevated albuminuria with mean value of urine albumine-to-creatinine ratio 1237mg/g (162 – 3240). 42% had overt proteinuria and acidosis. 

 

Conclusions:

Growth of infants with PUV after prenatal vesico-amniotic interventions who survive first 6 months is satisfactory. About half of them are at risk of impaired kidney function but the need of renal replacement therapy is very uncommon. Their survival is fraught with risk of recurrent urinary tract infections and hospitalizations