Outcome of fetuses with congenital anomalies of the kidney and urinary tract (CAKUT): a retrospective single center study

Introduction Congenital abnormalities of the kidney and the urinary tract (CAKUT) are among the most frequent causes of antenatal consultation and can have a poor outcome. Termination of pregnancy is frequently practiced in this situation. Thus, data on the outcome of fetuses with CAKUT are sparse. In this single center retrospective study, we report on the outcome of children with antenatal diagnosis of CAKUT between 2007 and 2018 in our clinic.

Methods All cases of antenatal diagnosis of CAKUT between 2007 and 2018 were evaluated. Twin pregnancies and cases with termination of pregnancy were excluded. Demographic data, sonographic data, delivery data and data on postnatal outcome were collected from the electronic database of our clinic and were analyzed. All ultrasound examinations were performed by advanced specialists in prenatal medicine certified by the German Association for Ultrasound in Medicine (DEGUM).

Results Of 64 pregnancies complicated by CAKUT, 23 were terminated and 41 were eligible for our study. Of 39 live births, 15 newborn (38.5%) died before discharge from hospital. All of them had an oligo- or ahydramnion. Median survival was 0.6 days. Twenty-four (61.5%) patients survived to hospital discharge. All patients that required respiratory support had an oligo- or ahydramnion. All 16 patients that did not require respiratory support in the delivery room were amongst survivors, as well as five newborn that had required invasive ventilation. Three newborn required RRT (peritoneal dialysis n=3). One patient was discharged on secondary palliative care, two additional patients died at 4.5 and 14.6 months due to sepsis. Twenty-one (53.8%) patients are alive with a median follow-up of 74.2 (16.8-107.4) months. At 3.0 and 4.7 years of age, two additional patients required RRT (peritoneal dialysis). Three patients have received a kidney transplant ([Abb. 1]).

Abb. 1  

Conclusions Pregnancies complicated by CAKUT can have a poor outcome, especially by concomitant presence of oligo- or ahydramnios [1]. In our cohort all infants with no need for respiratory support survived to hospital discharge. As data on the outcome of children with antenatal diagnosis of CAKUT is collectively sparse, more research is needed in order to be able to predict outcome in these cases and counsel couples accordingly.

Publication History

Article published online:
15 November 2023

• References

• 1 Melo BF, Aguiar MB, Bouzada MC, Aguiar RL, Pereira AK, Paixão GM, Linhares MC, Valerio FC, Simões E, Silva AC, Oliveira EA.. Early risk factors for neonatal mortality in CAKUT: analysis of 524 affected newborns. Pediatr Nephrol 2012; 27 (06) 965-72