Prenatal Detection of Fetal Renal and Urinary Tract Disorders Improves Perinatal Management: Study
Assessment of the fetal renal tract is a standard component of the routine mid-trimester anomaly scan. Renal disorders comprise approximately 20% of all lesions diagnosed antenatally in the fetus and are seen in 3–4% of all pregnancies. Most disorders are unilateral and usually carry a good prognosis.
Bilateral renal disorders often lead to fetal renal dysfunction, which may result in oligohydramnios. These cases require parental counselling, appropriate genetic analysis, and careful decisions regarding further management of pregnancy.
Antenatal detection of renal conditions is extremely important because it provides an opportunity for monitoring and selected interventions that may alter the course of postnatal complications such as renal failure and neonatal death.
This study aimed to identify fetal renal and urinary tract disorders, including renal parenchymal disorders, abnormalities of the collecting system, absence of one or both kidneys, appropriate investigations, and feto-maternal outcomes in a tertiary care center.
This single-centre prospective observational study included antenatal women with singleton pregnancies diagnosed with fetal renal or urinary tract disorders after informed consent and ethical approval. Ultrasonographic evaluation, genetic counselling, and relevant non invasive or invasive prenatal tests were performed. Fetuses were followed antenatally, and neonates were assessed at 1 week, 3 months, and 6 months after birth.
A total of 60 women were included, with 56% multigravida. Common fetal renal anomalies were UTD A1 (21), UTD A2/3 (16), multicystic kidney (10), and bilateral echogenic enlarged kidneys (5), including 2 cases of ARPKD. Other anomalies included BOO (3), unilateral renal agenesis (3), and ectopic kidney (2). Anhydramnios was seen in 20%, associated systemic anomalies in 18.3%, and soft markers in 13.3%. Serum screening in 19 women showed low
trisomy risk, while 10 amniocentesis reports were normal. Ten women opted for medical termination. Among the remaining pregnancies, 50 neonates were live born, of whom 10 had neonatal death. Two neonates underwent surgery, with one surviving after pyeloplasty.
UTD A1 has a good prognosis, whereas UTD A2/3 may require postnatal surgical intervention. BOO, multicystic kidney disease, and enlarged echogenic kidneys are associated with poor survival, while isolated renal agenesis and ectopic kidney have favorable outcomes. Genetic counselling, prenatal testing, neonatal surveillance, and timely intervention are important for improving perinatal outcomes.
Source: Mukherjee et al. / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):368–375
