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Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction

  • Chryso Pefkaros KatsoufisEmail author
Educational Review
Part of the following topical collections:
  1. What’s New in Chronic Kidney Disease

Abstract

Congenital lower urinary tract obstruction is associated with oligohydramnios and significant perinatal mortality and long-term chronic kidney disease. The counseling of families facing this diagnosis, especially when prenatal intervention is proposed, is fraught with ambiguity. This review aims to equip the provider with the current evidence behind the conventional and novel biomarkers predictive of chronic kidney disease. The relevant clinical predictors are categorized by when they are identified, antenatally or postnatally, and as either anatomic or chemical. They are considered for their prognostic value and the challenges in obtaining them, specifically the risk to the fetus in the case of prenatal biomarkers. Serum creatinine in infancy is the traditional chemical biomarker of kidney function and continues to be a consistent predictor of future serum creatinine. β-2 microglobulin may provide earlier information regarding fetal glomerular and tubular function and is also predictive of long-term serum creatinine. Renal parenchymal area is an anatomic surrogate of nephron mass that is used in both prenatal and postnatal settings. Understanding the anatomic and chemical biomarkers is essential for future refinement of the staging algorithm used to distinguish which patients may benefit from early in utero intervention.

Keywords

Congenital lower urinary tract obstruction Bladder outlet obstruction Posterior urethral valves Chronic kidney disease Megacystis Renal parenchymal area Vesicoamniotic shunt 

Notes

Acknowledgments

Carolyn Abitbol, MD, and Gaston Zilleruelo, MD, provided insightful comments on the manuscript.

Compliance with ethical standards

Conflict of interest

The author declares that there is no conflict of interest.

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© IPNA 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Division of Pediatric NephrologyUniversity of Miami Miller School of Medicine/Holtz Children’s HospitalMiamiUSA

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