Long-term follow-up of congenital anomalies of the kidney and urinary tract diagnosed in utero: a longitudinal study.

Abstract

Congenital-anomalies of the kidney-and-urinary-tract (CAKUT) are diagnosed in 3-6 per 1000 live-births. The objective of the current study was to examine the short and long-term outcomes of children diagnosed prenatally with CAKUT. A retrospective study was performed in 2018 on all pregnancies diagnosed with CAKUT between 2004 and 2008 at our hospital. Pregnancy outcomes and long-term morbidity were evaluated. Comparison was made between mildand severe forms of CAKUT and between unilateral and bilateral anomalies. Ninety-eight children were included in the study. Most of them were born with anadequateweight for gestational-age, and wereborn at term by vaginal-deliveries. Children with major renal anomalies suffered significantly more frequentlyfrom recurrent UTIs (33.3% vs. 8.4%), needed more preventive antibiotics (50% vs. 20.5%), and had more renal surgeries (75% vs. 28%) than those with milder forms ofCAKUT. Significantly more children with polycystic/multicystic kidney disease had recurrent UTIs (50% compared to 25% of the children with renal agenesis, and 5.6% of the children with hydronephrosis/hydroureter). There were no significant differences in the need for neurodevelopmental follow-up between the different groups of severity. Unilateral CAKUT patientsrequired longer periods of nephrologist follow-up and repeated sonographic exams compared to bilateral CAKUTpatients. Children with bilateral CAKUT more often neededspecial educational support thanpeers with unilateraldisease (29.4% vs. 11.1%, P = 0.03). Pregnancies whose children are diagnosed withCAKUTin utero usuallydeliver at term, with adequate-weight for gestational-age. The most common long-term comorbidities in children were recurrent UTIs and the use of preventive antibioticswasoften needed. Expecting couples can be reassured of a generally good outcome oftheir children, at leastduring the first decade of life.