La Biochimica urinaria del feto ottenuta con cistocentesi: utilità clinica nelle gravi uropatie fetali

[Autom. eng. transl.] Introduction: Management of obstructive uropathy in the prenatal phase cannot be done without invasive and non-invasive diagnostics. The most frequent invasive diagnostic approach is ultrasound-guided cystocentesis, with fetal urine taken at the point of transfission. Fetal urinary biochemistry is crucial in the choice of the most appropriate invasive approach. The aim of the work was to demonstrate that repeated cystocentesis (2 cases) can be diagnostic and therapeutic, leading to improvements in the fetal bladder detrusor, contributing to the perinatal outcome. Materials and methods: First patient: 26th week with diagnosis of abdominal sinus mass (suspected multicystic dysplastic kidney). Second patient: 14th week with diagnosis of fetal megavescica. In both, 7 ultrasound-guided cystocentesis were performed. Fetal urine samples were assayed: electrolytes, creatinine, microalbuminuria and osmolality (C 311 Roche, BNII Siemens, Osmometer AI). Results: The renal function parameters, in the first case, were always high index of a compromised functionality. At 4 days of age, the child was subjected to nefroureterectomy sn, with a definitive diagnosis of segmental renal dysplasia. The cistouretrography performed at 3 months of life showed: healthy right renal parenchyma, with normal renal function. In the second case the biochemical tests on fetal urine showed a normal functionality of the renal parenchyma even in the presence of megavescica (Prune-Belly syndrome), confirmed postnally. At birth the general conditions were discrete with biochemical parameters and normal urinary tract ultrasonography. Conclusions: The use of invasive ultrasound-guided techniques has allowed us to consider the fetus as a "patient" and the invasive approach can be carried out with a low risk-benefit ratio. , leading pregnancies up to the 37th and 38th week, respectively, with an appropriate intervention and without aggressive treatment. The biochemical tests have been of great support for the formulation of the diagnosis confirmed at the birth of the children and for detente the distension of the fetal megavescica.