Exploration of postnatal integrated management for prenatal renal and urinary tract anomalies in China

Abstract

Objective: The aim of this prospective observational study was to establish a suitable model for the postnatal follow-up and management of prenatal renal and urinary tract anomalies in Shanghai, China.

Methods: Minhang and Changning maternal child health care hospitals were selected to establish the integrated management model. Newborns with prenatal renal and urinary tract anomalies in these two centers were eligible to participate in the study from 2015 to 2017. All newborns were classified into three groups based on prenatal findings: (1) severe/complex urinary tract dilatation (UTD) with ureterectasia, (2) other renal and urinary tract abnormalities, and (3) isolated mild to moderate UTD. The newborns underwent their first postnatal ultrasound and follow-up according to the presumed management strategy. Demographic and clinical data were collected from all institutes.

Results: A total of 129 newborns fulfilled the study criteria, and 121 completed the postnatal evaluation. Ten newborns in group 1 (n = 13) were diagnosed with obstructive uropathy, including 9 with ureteropelvic junction obstruction (UPJO) and one with megaureter. All 13 newborns in group 2 had consistent postnatal results and were followed under previously established procedures. Sixty-seven cases in group 3 (n = 95) had a UTD at their first scan at 42 postnatal days, and two were diagnosed with UPJO. A total of 2 infants with UPJO underwent surgery, and 71 (65.7%, 71/108) of the UTD cases were resolved.

Conclusions: The majority of the patients had a favorable outcome. Close multidisciplinary collaboration among obstetricians, neonatologists, pediatricians, and pediatric nephrologists and urologists is mandatory.

Keywords:

• Congenital anomalies of the kidney and urinary tract (CAKUT)
• integrated management
• outcome
• postnatal
• prenatal

Acknowledgements

The authors thank all the obstetricians and neonatologists at Minhang and Changning Maternal and Child Health Hospitals for counseling and educating parents during pregnancy and early after birth.

Disclosure statement

None of the authors have had any financial interest in any products, devices, or drugs used in the manuscript. There is no conflict of interest related to any commercial associations or financial relationships (consultancy, stock ownership, equity interest, patent licensing arrangements, or payments for conducting or publicizing the study contained in the manuscript).

Ethical approval

The study was approved by the Research Ethical Committee of Children’s Hospital of Fudan University.

Additional information

Funding

This work was supported by the Shanghai Public Health Three-Year Action Plan (2015–2017) sponsored by Shanghai Municipal Health Commission under grant (number: GWIV14.2), Chronic Disease Prevention and Control Project sponsored by Shanghai Hospital Developmental Center under grant (number: SHDC12015301), Shanghai Medical Talents Program (2015), and Public Welfare Scientific Research by Ministry of Health under grant (number: 201002006).