Follow-up of infants with bilateral renal disease detected in utero. Growth and renal function
V. M. Reznik, G. W. Kaplan, J. L. Murphy, M. G. Packer, D. Boychuck, W. R. Griswold, G. R. Leopold and S. A. Mendoza
Department of Pediatrics, UCSD School of Medicine, La Jolla 92093.
We studied 69 infants who had urinary tract abnormalities detected by
antenatal ultrasound examination. There were 21 intrauterine or immediate
neonatal deaths; in all 21 infants, severe bilateral renal disease
incompatible with life was found at autopsy. Six of the live-born infants
with abnormal results of antenatal ultrasound examinations had a normal
urinary tract after birth. Of the remaining 42 infants, the prenatal
diagnosis was confirmed with renal ultrasound and other studies during the
first week of life. Twenty-one of 42 infants had bilateral renal disease.
We obtained follow-up data on 19 of 21 of these infants. Twelve of 19 had
obstructive uropathy that was treated surgically. After one to 51 (mean,
18) months of follow-up, renal function varied. Ten of 19 patients had a
calculated glomerular filtration rate greater than or equal to 79
mL/min/1.73 m2. One infant required long-term ambulatory peritoneal
dialysis. Renal function (glomerular filtration rate, 74 +/- 5 mL/min/1.73
m2) and growth (height percentile, 41 +/- 8) were unexpectedly good
considering the severity of the urinary tract abnormalities. Prenatal
detection of bilateral renal disease followed by careful medical and
surgical management results in a favorable outcome with good growth and
renal function.
