Clinical course of 822 children with prenatally detected nephrouropathies.

Summary Background and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinarytract (CAKUT)inuterohas permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies. Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest. Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02–1.70,P=0.05); 22 patients (2.7%) had hypertension, and49 (6%) patients developed CKD.TheriskofCKDwasgreaterinpatientswithassociatedhydronephrosis(hazardratio=5.20,95%confidence interval=2.90–9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60–22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90–29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00–228.00, P,0.001). ConclusionsInour series,theclinical courseofprenatallydetectedCAKUT was heterogeneous,andthoseinfants with associated hydronephrosis at baseline were identified as a high-risk subgroup. Clin J Am Soc Nephrol 7: 444–451, 2012. doi: 10.2215/CJN.03400411