ArticleJournal of Indian Association of Pediatric Surgeons
Prenatal Ultrasound Grading in Prognostication of Neonates with Posterior Urethral Valves.
Article in Journal of Indian Association of Pediatric Surgeons. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Posterior urethral valves (PUVs) are a major cause of congenital lower urinary tract obstruction and long-term chronic kidney disease (CKD). This study was aimed to evaluate the utility of a simplified prenatal ultrasound grading (PUG) system to assess CKD progression. Methods: This retrospective case series included inborn neonates with antenatally diagnosed PUV managed at a tertiary center between 2010 and 2020. Postnatally detected or referred cases and those without complete follow-up were excluded. PUG was assigned at 32 weeks' gestation using prenatal ultrasound findings (no fetal urine sampling): PUG-1 (normal amniotic fluid index and renal echogenicity), PUG-2 (oligohydramnios with normal echogenicity), and PUG-3 (anhydramnios and/or increased echogenicity). Postnatal management included primary valve ablation or urinary diversion based on gestation and PUG category. The primary outcome was CKD stage ≥3 as per KDIGO criteria. Results: Fifty-eight neonates (42 term and 16 preterm) had complete follow-up (median: 7 years). Among all neonates, CKD occurred in 1/28 with PUG-1, in 5/21 with PUG-2, and in 8/9 with PUG-3 ( Conclusion: Primary valve ablation is safe in low-/intermediate-risk preterm neonates with PUV. CKD risk increases as PUG progresses. PUG shows promising prognostic application; larger validation studies are warranted.
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