TY - JOUR
T1 - Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group
AU - Capone, Valentina
AU - Persico, Nicola
AU - Berrettini, Alfredo
AU - Decramer, Stèphane
AU - De Marco, Erika Adalgisa
AU - De Palma, Diego
AU - Familiari, Alessandra
AU - Feitz, Wout
AU - Herthelius, Maria
AU - Kazlauskas, Vytis
AU - Liebau, Max
AU - Manzoni, Gianantonio
AU - Maternik, Michal
AU - Mosiello, Giovanni
AU - Schanstra, Joost Peter
AU - Vande Walle, Johan
AU - Wühl, Elke
AU - Ylinen, Elisa
AU - Zurowska, Aleksandra
AU - Schaefer, Franz
AU - Montini, Giovanni
PY - 2022
Y1 - 2022
N2 - Fetal lower urinary tract obstruction (LUTO) is associated with high mortality and postnatal morbidity caused by lung hypoplasia and impaired kidney function. Specific diagnostic features that can guide clinical approach and decisions are lacking; thus, the European Reference Network for Rare Kidney Diseases established a work group to develop recommendations regarding the clinical definition, diagnosis and management of prenatally detected LUTO. The work group recommends the use of antero-posterior diameter of renal pelvis as the most reliable parameter for suspecting obstructive uropathies and for suspecting prenatal LUTO in the presence of fetal megacystis. Regarding prenatal and postnatal prognosis of fetuses with LUTO, the risk of fetal and neonatal death depends on the presence of oligohydramnios or anhydramnios before 20 weeks’ gestation, whereas the risk of kidney replacement therapy cannot be reliably foreseen before birth. Parents of fetuses with LUTO must be referred to a tertiary obstetric centre with multidisciplinary expertise in prenatal and postnatal management of obstructive uropathies, and vesico-amniotic shunt placement should be offered in selected instances, as it increases perinatal survival of fetuses with LUTO.
AB - Fetal lower urinary tract obstruction (LUTO) is associated with high mortality and postnatal morbidity caused by lung hypoplasia and impaired kidney function. Specific diagnostic features that can guide clinical approach and decisions are lacking; thus, the European Reference Network for Rare Kidney Diseases established a work group to develop recommendations regarding the clinical definition, diagnosis and management of prenatally detected LUTO. The work group recommends the use of antero-posterior diameter of renal pelvis as the most reliable parameter for suspecting obstructive uropathies and for suspecting prenatal LUTO in the presence of fetal megacystis. Regarding prenatal and postnatal prognosis of fetuses with LUTO, the risk of fetal and neonatal death depends on the presence of oligohydramnios or anhydramnios before 20 weeks’ gestation, whereas the risk of kidney replacement therapy cannot be reliably foreseen before birth. Parents of fetuses with LUTO must be referred to a tertiary obstetric centre with multidisciplinary expertise in prenatal and postnatal management of obstructive uropathies, and vesico-amniotic shunt placement should be offered in selected instances, as it increases perinatal survival of fetuses with LUTO.
KW - fetal ultrasound
KW - prenatal diagnosis
KW - fetal ultrasound
KW - prenatal diagnosis
UR - http://hdl.handle.net/10807/274368
U2 - 10.1038/s41585-022-00563-8
DO - 10.1038/s41585-022-00563-8
M3 - Article
SN - 1759-4812
VL - 19
SP - 295
EP - 303
JO - NATURE REVIEWS. UROLOGY
JF - NATURE REVIEWS. UROLOGY
ER -