Estudo longitudinal da associação entre achados ultrassonográficos antenatais do sistema nefrourinário com a ocorrência de desfechos clínicos nos períodos pós-natal, infância e adolescência, em paciêntes com anomalias congênitas do rim e do trato urinário

Abstract

Background: Recent advances in obstetric ultrasound have led to early diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) during antenatal care. Patients with CAKUT may present with unfavorable clinical outcomes thoroughout life.Objectives:this study aimed to associate antenatal nephrourinary ultrasonographic findings with clinical outcomes during postnatal period, childhood and adolescence, in patients with CAKUT.Patients and Methods:Retrospective cohort study of 823 patients with CAKUT seen at the Fetal Medicine Center of Hospital das Clínicas Universidade Federal de Minas Gerais (HC-UFMG) and referred to the Pediatric Nephrology Unit of HC-UFMG after delivery. Median follow-up time was 58.7 months.The nephrourinary ultrasonographic findings detected at the last exam prior delivery were associated with the need for surgical treatment, occurrence of urinary tract infection (UTI), urinary tract infection among patients on chemoprophylaxis, development of chronic kidney disease (CKD), end-stage chronic kidney disease (ESKD) and death.Pearson´s and Fisher´s exact chi-squared tests were used in the statistical analysis. Odds ratio was used to determine the prognostic value of the antenatal ultrasonographic findings.Results:In patients with CAKUT, the nephrourinary ultrasonographic findings that presented statistical significant association with the clinical outcomes, in comparison to patients with CAKUT without such findings were: unilateral hydronephrosis (reduction of 42.5% in the chance of UTI in patients on chemoprophylaxis, 82.9% in the chance of CKD, 89,8% in the chance of ESKD and 2.8% in the chance of death); unilateral isolated hydronephrosis (reduction of 57% in the chance of UTI in patients on chemoprophylaxis, 89.5% in the chance of CKD,87.7% in the chance of ESKD and 2.5% in the chance of death);bilateral isolated hydronephrosis (reduction of 30.7% in the chance of surgery and 90.7% in the chance of ESKD); unilateral renal cysts (66.1% reduction in the chance of surgery); bilateral hydronephrosis(1.7-fold increase in the chance of UTI in patients on chemopropylaxis, 4.3-fold increase in the chance of CKD,4.7-fold increase in the chance of ESKD and 4.8-fold increase in the chance of death);unilateral megaureter (2.9-fold increase in the chance of UTI); bilateral megaureter (5.9-fold increase in the chance of surgery, 7.7-fold increase in the chance of hypertension, 3.5-fold increase in the chance of UTI, 3.6-fold increase in the chance of UTI in patients on prophylaxis,11.8-fold increase in the chance of CKD, 17.9-fold increase in the chance of ESKD and14.5-fold increase in the chance of death), megabladder(7.9-fold increase in the chance of surgery, 10.6-fold increase in the chance of hypertension, 3.9-fold increase in the chance of UTI, 4.4-fold increase in the chance of UTI in patients on prophylaxis, 24.7-fold increase in the chance of CDK, 35.8-fold increase in the chance of ESKD and 15.4-fold increase in the chance of death); oligohydramnio (6-fold increase in the chance of surgery, 4.9-fold increase in the chance of UTI, 30-fold increase in the chance of CKD, 40-fold increase in the chance of ESKD and 14.5-fold in chance in the of death); unilateral hydronephrosis with megaureter (2.9-fold increase in the chance of CKD and 2.4-fold increase in the chance of UTI in patients on prophylaxis); bilateral hydronephrosis with megaureter (6.8-fold increase in the chance of CKD, 10.8-fold increase in the chance of ESKD and 13.3-fold increase in the chance of death);bilateral hydronephrosis with megaureter and megabladder (10.8-fold increase in the chance of surgery, 12.7-fold increase in the chance of hypertension, 4-fold increase in the chance of UTI, 4.3- fold increase in the chance of UTI in patients on prophylaxis, 10.1-fold increase in the chance of death, 12.2-fold increase in the chance of CKD and15.5-fold increase in the chance of ESKD); bilateral hydronephrosis with megabladder and oligohydramnio (5.2-fold increase in the chance of surgical treatment, 23-fold increase in the chance of death,150.8-fold increase in the chance of CKD and 93.8-fold increase in the chance of ESKD).Conclusion: Our study revealed the nephrourinary ultrasonographic findings which are associated with the reduction and the increase of unfavorable clinical outcomes in patients with CAKUT, leading to better gestational counseling.