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ASSESSMENT OF CAKUT PREGNANCY OUTCOME USING MULTIPLE ULTRASOUND FEATURES
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Edité par CCSD -
International audience. Introduction: Anomalies of the kidney and the urinary tract (CAKUT) have a wide spectrum of outcomes ranging from normal postnatal kidney function to fetal death. Although often already discovered in utero, the ultrasound workup does not allow an accurate assessment of outcome. Our study aimed to clarify the relationship between ultrasound data and outcome.Material and methods: For a total of 136 fetuses with bilateral CAKUT (except bilateral agenesis) and a 2-year postnatal follow-up, we collected data on amniotic fluid (AF) volume, number of functional kidneys, and presence of renal dysplasia or cysts using a standardized ultrasound-based observation protocol. Cramers V was used to measure the strength of 2-to-2 dependence of changes. Logistic regression analysis was conducted to study the association of ultrasound features with postnatal renal survival. The AF proteome related to dysplasia or cysts was characterized by LC–MS/MS using 22 healthy fetuses and a subset of 36 CAKUT fetuses.Results: Fourty-two CAKUT patients had oligohydramnios whereas 12 displayed anyhydramnios; 9 had a single kidney; unilateral renal dysplasia was found in 24 fetuses while bilateral dysplasia occurred in 65; cysts were detected in one or both kidneys in 22 and 76 cases, respectively. Dysplasia was significantly associated with both AF volume (Cramer’s V:0.24) and the presence of cysts (Cramer’s V:0.44). Reduced AF volume (OR=132 [95%CI:21-2666]), dysplasia occurrence (OR=31 [95%CI:3-785]) and presence of cysts (OR=16 [95%CI:1-460]) were identified as independent risk factors of poor prognosis. Combination of the 3 features yielded an area under the receiver operator characteristic curve of 0.92 for prediction of renal postnatal outcome in leave-one-out cross validation. Functional enrichment analysis of the AF proteome led to association of dysplasia with the term extracellular matrix organization and cysts with immunity.Conclusions: A more detailed exploitation of the antenatal ultrasound-based changes could improve prenatal clinical advice in CAKUT pregnancies.
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