Fetal renal impairment

Vanderheyden, Tina, Kumar, Sailesh and Fisk, Nicholas M. (2003) Fetal renal impairment. Seminars in Neonatology, 8 4: 279-289. doi:10.1016/S1084-2756(03)00022-8

Author Vanderheyden, Tina
Kumar, Sailesh
Fisk, Nicholas M.
Title Fetal renal impairment
Journal name Seminars in Neonatology   Check publisher's open access policy
ISSN 1084-2756
Publication date 2003-08-01
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S1084-2756(03)00022-8
Volume 8
Issue 4
Start page 279
End page 289
Total pages 11
Place of publication London, U.K.
Publisher W. B. Saunders
Language eng
Subject 111401 Foetal Development and Medicine
111402 Obstetrics and Gynaecology
1103 Clinical Sciences
Formatted abstract
Renal function in utero deals chiefly with urine production rather than the excretion of metabolites, which are cleared by the placenta. Fetal renal impairment (FRI) in bilateral renal disease thus presents as oligohydramnios or anhydramnios; this can lead to lung hypoplasia and early neonatal death. As in the adult, FRI can be divided into prerenal, renal and postrenal causes. Causes of prerenal FRI include intrauterine growth restriction, unbalanced intertwin transfusion in monochorionic twins and maternal drug ingestion. Bilateral renal agenesis, multicystic dysplasia and both the autosomal dominant and recessive forms of polycystic kidney disease are examples of renal causes, whereas postrenal etiologies are usually caused by lower urinary tract obstruction (LUTO). When both kidneys are affected and there is severe mid-trimester oligohydramnios, the prognosis is poor. Although animal studies have shown that prolonged LUTO leads to lung hypoplasia and renal damage, and that decompression of the fetal kidney in early pregnancy restores fetal pulmonary and renal function, the value of fetal therapy such as vesico-amniotic shunting remains controversial, with a high procedure-related complication rate and a high incidence of end-stage renal failure in childhood. Fetal cystoscopic treatment of posterior urethral valves in utero may obviate some of these difficulties but remains an investigational procedure.
Copyright © 2003 Elsevier Ltd. All rights reserved.

Keyword Lung hypoplasia
Fetal urine analysis
Fetal kidney function
Renin–angiotensin system
Renal agenesis
Maternal drug intake
Prenatal diagnosis
Posterior urethral valves
Fetal therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Issue editor: Neena Modi. Issue title: Fluid Balance and Renal Function Journal currently titled Seminars in Fetal & Neonatal Medicine.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Mon, 23 Mar 2009, 21:52:03 EST by Maria Campbell on behalf of Faculty Of Health Sciences