Antenatal oligohydramnios of renal origin: postnatal therapeutic and prognostic challenges

Clin Nephrol. 2001 Dec;56(6):S9-12.

Abstract

Urinary tract anomalies (UTA) including polycystic kidney disease nowadays can be detected antenatally by ultrasound. The concomitant presence of oligohydramnios has been regarded as a severe risk factor for renal dysfunction and pulmonary hypoplasia, although clinical data after birth are scarce. We report the postnatal course and long-term follow-up of 10 infants with oligohydramnios due to congenital UTA from two pediatric nephrology centers. The underlying final diagnoses were autosomal-recessive polycystic kidney disease (ARPKD, n = 2), familial tubular dysgenesis (n = 2) and bilateral renal hypoplasia (n = 6) including 3 children with posterior urethral valves. Two children died in the neonatal period while 8 children are currently alive at a median age of 2.5 (range 1.1-10) years. In the postnatal period, respiratory failure necessitating mechanical ventilation occurred in 7 infants (including the 2 non-survivors). All surviving children had chronic renal failure, which could be managed conservatively in 6 children (median GFR 45 (range 15-53) ml/min/1.73 m2) while 2 reached end-stage renal disease; one undergoing preemptive kidney transplantation and one peritoneal dialysis. Seven of 8 children reached normal developmental milestones. In conclusion, the presence of antenatal oligohydramnios in infants with UTA does not always carry a poor prognosis. The high incidence of perinatal complications, the complexity of underlying causes and the prevalence of postnatal chronic renal dysfunction calls for a multidisciplinary approach in the management of these children.

MeSH terms

  • Female
  • Fetal Diseases / diagnostic imaging*
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Male
  • Oligohydramnios / diagnostic imaging*
  • Oligohydramnios / etiology
  • Polycystic Kidney Diseases / complications
  • Polycystic Kidney Diseases / diagnostic imaging*
  • Pregnancy
  • Pregnancy Complications*
  • Prognosis
  • Respiratory Distress Syndrome, Newborn / etiology
  • Respiratory Distress Syndrome, Newborn / therapy
  • Retrospective Studies
  • Ultrasonography, Prenatal*
  • Urinary Tract / abnormalities*
  • Urinary Tract / diagnostic imaging
  • Ventilators, Mechanical