Evaluation of nephroamnial bypass efficiency in a fetus with obstructive uropathies
DOI: 10.32364/2618-8430-2025-8-2-1
N.V. Kosovtsova, N.A. Fyodorova
Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation
Aim: to evaluate efficiency of intrauterine nephroamnial bypass in a fetus to manage obstructive uropathies and to discuss obstetric tactics.
Materials and Methods: 57 patients with obstructive fetal uropathy were managed in the Ural Research Institute for Maternal and Infant Health from 2018 to 2022. During the study, the patients were divided into two groups: a main group and a comparison group. In the main group (n=37), fetal hydronephrosis (grades III–IV) had ultrasound signs of preserved kidney function. Along with this, fetal urinary system was decompensated in the comparison group (n=20). All fetuses underwent ultrasonic examination and magnetic resonance imaging. To assess preservation of kidney function, a complete clinical, laboratory and ultrasound examination of children was performed in the early neonatal period and within the 1st year of life.
Results: on average, congenital fetal urinary malformations were detected at 20–21 weeks of pregnancy. The period of admission to an obstetric hospital level 3 is 26–28 weeks. All patients of the main group underwent intrauterine nephroamnial bypass (in most cases, at 22–32 weeks of pregnancy). During a follow-up of a fetal urinary system, reliable ultrasound signs of efficient nephroamnial bypass (i.e., complete void of renal collecting system, increased thickness of renal parenchyma) were detected. Stent migration (16,2%), premature labor (21,6%), and premature discharge of amniotic fluid (13,5%) are complications of nephroamnial bypass. In the comparison group, indicators of pregnancy course and outcomes are worse than those in the main group. Most of the main group patients were delivered at full-term pregnancy, while premature births were reported in 50% of the comparison group. Evaluation of the early neonatal period and the first year of life demonstrated that incidence of chronic renal failure and secondary shrunken kidney is significantly higher in the comparison group.
Conclusion: in the authors' opinion, early prenatal diagnosis, as well as timely intrauterine and postnatal surgical treatment can help to prevent complications and to maintain normal functional activity of the urinary system in a newborn which is a priority factor.
Keywords: obstructive uropathies, intrauterine nephroamnial bypass, renal failure, secondary shrunken kidney.
For citation: Kosovtsova N.V., Fyodorova N.A. Evaluation of nephroamnial bypass efficiency in a fetus with obstructive uropathies. Russian Journal of Woman and Child Health. 2025;8(2):94–99 (in Russ.). DOI: 10.32364/2618-8430-2025-8-2-1
ABOUT THE AUTHORS:
Natalia V. Kosovtsova — D. Sc. (Med.), Head of the Department of Biophysical Research Methods, Ural Research Institute for Maternal and Infant Health; 1, Repina str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0000-0002-4670-798X
Natalia A. Fedorova — obstetrician-gynecologist, postgra-duate student, Ural Research Institute for Maternal and Infant Health; 1, Repina str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0000-0003-1474-4978
Contact information: Natalya A. Fedorova, e-mail: fedotova.natasha95@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 12.03.2025.
Revised 04.04.2025.
Accepted 29.04.2025.
2. Nef S., Neuhaus T.J., Spartà G. et al. Outcome after prenatal diagnosis of congenital anomalies of the kidney and urinary tract. Eur J Pediatr. 2016;175(5):667–676. DOI: 10.1007/s00431-015-2687-1
3. Sandulescu S.M., Vicol R.M., Serban A. et al. Congenital Anomalies of Urinary Tract and Anomalies of Fetal Genitalia. In: Congenital Anomalies — From the Embryo to the Neonate. 2018:287–307. DOI: 10.5772/intechopen.73641
4. Stein D., McNamara E. Congenital Anomalies of the Kidneys and Urinary Tract. Clin Perinatol. 2022;49(3):791–798. DOI: 10.1016/j.clp.2022
5. Гус А.И., Костюков К.В. Значение современных трехмерных эхографических технологий в диагностике врожденных обструктивных уропатий у плода. Журнал акушерства и женских болезней. 2014;63(1):50–51. DOI: 10.17816/JOWD63150-51Gus A.I., Kostyukov K.V. The importance of modern three-dimensional echographic technologies in the diagnosis of congenital obstructive uropathies in the fetus. Journal of Obstetrics and Women's Diseases. 2014;63(1):50–51 (in Russ.). DOI: 10.17816/jowd63150-51
6. Koenigbauer J.T., Fangmann L., Reinhardt C. et al. Spectrum of congenital anomalies of the kidney and urinary tract (CAKUT) including renal parenchymal malformations during fetal life and the implementation of prenatal exome sequencing (WES). Arch Gynecol Obstet. 2024;309(6):2613–2622. DOI: 10.1007/s00404-023-07165-8
7. Косовцова Н.В., Куклин Е.С., Федорова Н.А. Новый взгляд на тактику ведения пациенток с обструктивными уропатиями плода. Доктор.Ру. 2023;22(5):26–33. DOI: 10.31550/1727-2378-2023-22-5-26-33Kosovtsova N.V., Kuklin E.S., Fedorova N.A. A new look at the management tactics of patients with obstructive fetal uropathies. Doctor.ru. 2023;22(5):26–33 (in Russ.). DOI: 10.31550/1727-2378-2023-22-5-26-33
8. Косовцова Н.В., Маркова Т.В., Башмакова Н.В., Чистяков М.А. Шунтирование почек плодов в эксперименте на животных. Экспериментальная и клиническая урология. 2017;2:20–25.Kosovtsova N.V., Markova T.V., Bashmakova N.V., Chistyakov M.A. Kidney bypass surgery in animal fetuses in experimental condition. Experimental and Clinical Urology. 2017;2:20–25 (in Russ.).
9. Косовцова Н.В., Павличенко М.В., Башмакова Н.В., Маркова Т.В. Эффективность внутриутробной хирургической коррекции обструктивных уропатий. Лечение и профилактика. 2018;8(3):33–39.Kosovtsova N.V., Pavlichenko M.V., Bashmakova N.V., Markova T.V. The results of surgical correction of fetal obstructive uropathy. Disease Treatment and Prevention. 2018;8(3):33–39 (in Russ.).
10. Косовцова Н.В., Павличенко М.В., Макаров Р.А. и др. Внутриутробная коррекция обструктивных уропатий способом двустороннего нефроамниального шунтирования почек плода. Акушерство и гинекология. 2020;12:200–208. DOI: 10.18565/aig.2020.12.200-208Kosovtsova N.V., Pavlichenko M.V., Makarov R.A. et al. Intrauterine correction of obstructive uropathies by bilateral nephroamnial bypass grafting of the fetal kidneys. Obstetrics and Gynecology. 2020;12:200–208 (in Russ.).
11. Grignon A., Filion R., Filiatrault D. et al. Urinary tract dilatation in utero: classification and clinical applications. Radiology. 1986;160(3):645–647. DOI: 10.1148/radiology.160.3.3526402
12. Косовцова Н.В., Башмакова Н.В., Маркова Т.В. Стент почечный. Патент на изобретение RU 152166U1. Опубликовано 10.05.2015.Kosovtsova N.V., Bashmakova N.V., Markova T.V. Renal stent. Patent RU 152166U1. Date of publication: 10.05.2015 (in Russ.).
13. American Association for the Advancement of Science. Science 80. Volume 4, issues 1-5, 72; Publisher: American Association for the Advancement of Science; 1983.
14. Cheung K.W., Morris R.K., Kilby M.D. Congenital urinary tract obstruction. Best Pract Res Clin Obstet Gynaecol. 2019;58:78–92. DOI: 10.1016/j.bpobgyn.2019.01.003
15. Ruano R., Dunn T., Braun M.C. et al. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatric Nephrology. 2017;32(10):1871–1878. DOI: 10.1007/s00467-017-3593-8
16. Kosovtsova N.V., Bashmakova N.V., Pavlichenko M.V. et al. Outcome of prenatal interventions for fetal lower urinary tract obstruction. Science and World. 2015;9(1):109–112.
17. Matsell D.G. Congenital Urinary Tract Obstruction — Diagnosis and Management in the Fetus. Nephrology and Fluid Electrolyte Physiology. 2019;3:391–409. DOI: 10.1016/B978-0-323-53367-6.00021-2
18. Некрасова Е.С. Ультразвуковая пренатальная диагностика и тактика ведения беременности при обструкции нижних отделов мочевыделительной системы плода. Ультразвуковая и функциональная диагностика. 2011;2:7–62.Nekrasova E.S. Ultrasound prenatal diagnostics and tactics of pregnancy management in case of obstruction of the lower urinary tract of the fetus. Ultrasound and functional diagnostics. 2011;2:57–62 (in Russ.).
19. Saccone G., D'Alessandro P., Escolino M. et al. Antenatal intervention for congenital fetal lower urinary tract obstruction (LUTO): a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020;33(15):2664–2670. DOI: 10.1080/14767058.2018.1555704
20. Strizek B., Gottschalk I., Recker F. et al. Vesicoamniotic hunting for fetal megacystis in the first trimester with a Somatex intrauterine shunt. Arch Gynecol Obstetr. 2020;302(1):133–140. DOI: 10.1007/s00404-020-05598-z
21. Strizek B., Spicher T., Gottschalk I. et al. Vesicoamniotic Shunting before 17 + 0 Weeks in Fetuses with Lower Urinary Tract Obstruction (LUTO): Comparison of Somatex vs. Harrison Shunt Systems. J Clin Med. 2022;11(9):2359. DOI: 10.3390/jcm11092359
22. Nassr A.A., Ruano R., Espinoza J. et al. Successful in utero Percutaneous Fetoscopic Release of a Wrapped Pleuro-Amniotic Shunt around the Fetal Arm: Case Report and Review of the Literature. Fetal Diagn Ther. 2016;43(2);156–160. DOI: 10.1159/000450606
23. Sheth K.R., Danzer E., Johnson E. et al. Development and in-vitro characterization of a novel fetal vesicoamniotic shunt — The Vortex shunt. Prenat Diagn. 2022;42(2):164–171. DOI: 10.1002/pd.6096
24. Косовцова Н.В., Павличенко М.В., Маркова Т.В., Куклин Е.С. Способ малоинвазивного внутриутробного двухстороннего нефро-амниального шунтирования для коррекции двухсторонних обструктивных уропатий. Патент на изобретение RU 2728944 C1. Опубликовано 08.08.2020.Kosovtsova N.V., Pavlichenko M.V., Markova T.V., Kuklin E.S. A method of minimally invasive intrauterine bilateral nephromnia bypass surgery for the correction of bilateral obstructive uropathies. Patent for invention RU 2728944 C1. Date of publication 08.08.2020 (in Russ.).
25. Косовцова Н.В., Федорова Н.А., Поспелова Я.Ю. Способ определения показаний к внутриутробному шунтирующему оперативному вмешательству путем оценки состоятельности паренхимы почки при уриномах и терминальных гидронефрозах у плода с помощью внутриутробной пункционной методики. Патент на изобретение RU 2812400C1. Опубликовано 30.01.2024.Kosovtsova N.V., Fedorova N.A., Pospelova Ya.Yu. A method for determining indications for intrauterine shunt surgery by assessing the viability of the kidney parenchyma in urinomas and terminal hydronephrosis in the fetus using the intrauterine puncture technique. Patent RU 2812400C1. Date of publication 30.01.2024 (in Russ.).
26. Косовцова Н.В., Башмакова Н.В., Сытых О.Н. и др. Первый опыт применения плевроамниального шунтирования. Доктор.Ру. 2021;20(1):38–44. DOI: 10.31550/1727-2378-2021-20-1-38-44Kosovtsova N.V., Bashmakova N.V., Sytykh O.N. et al. First Experience in Pleural-Amnion Grafting. Doctor.Ru. 2021;20(1):38–44 (in Russ.). DOI: 10.31550/1727-2378-2021-20-1-38-44
27. Косовцова Н.В., Павличенко М.В., Поспелова Я.Ю. и др. Способ малоинвазивного внутриутробного плевро-амниального шунтирования для внутриутробной коррекции гидроторакса у плода. Патент на изобретение RU 2744764 C1. Опубликовано 15.03.2021.Kosovtsova N.V., Pavlichenko M.V., Pospelova Ya.Yu. et al. A method of minimally invasive intrauterine pleuro-amniotic bypass surgery for intrauterine correction of hydrothorax in the fetus. Patent for the invention RU 2744764 C1. Date of publication 15.03.2021 (in Russ.).
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