Department of Obstetrics and Prenatal Medicine, University of Bonn Medical School, Bonn, Germany.
PLoS One. 2013 May 22;8(5):e63664. doi: 10.1371/journal.pone.0063664. Print 2013.
We analyzed the association between renal and cardiovascular parameters in fetuses with isolated severe urinary tract malformations.
39 fetuses at a mean gestational age of 23.6 weeks with nephropathies or urinary tract malformations and markedly impaired or absent renal function were prospectively examined. Fetal echocardiography was performed, and thicknesses of the interventricular septum, and left and right ventricular wall were measured. Blood flow velocity waveforms of the umbilical artery, middle cerebral artery, and ductus venosus were obtained by color Doppler ultrasound. Concentrations of circulating n-terminal pro-B-type natriuretic peptide (nt-proBNP), cystatin C, ß2-microglobulin, and hemoglobin were determined from fetal blood samples.
Malformations included 21 cases of obstructive uropathy, 10 fetuses with bilateral nephropathy, and 8 cases of bilateral renal agenesis. Marked biventricular myocardial hypertrophy was present in all cases. The ratio between measured and gestational age-adjusted normal values was 2.01 (interventricular septum), 1.85, and 1.78 (right and left ventricular wall, respectively). Compared to controls, levels of circulating nt-proBNP were significantly increased (median (IQR) 5035 ng/L (5936 ng/L) vs. 1874 ng/L (1092 ng/L); p<0.001). Cystatin C and ß2-microglobulin concentrations were elevated as follows (mean ± SD) 1.85±0.391 mg/L and 8.44±2.423 mg/L, respectively (normal range 1.66±0.202 mg/L and 4.25±0.734 mg/L, respectively). No correlation was detected between cardiovascular parameters and urinary tract morphology and function. Despite increased levels of nt-proBNP cardiovascular function was preserved, with normal fetal Doppler indices in 90.2% of cases.
Urinary tract malformations resulting in severe renal impairment are associated with biventricular myocardial hypertrophy and elevated concentrations of circulating nt-proBNP during fetal life. Cardiovascular findings do not correlate with kidney function or morphology.
分析孤立性严重尿路畸形胎儿的肾脏和心血管参数之间的关系。
前瞻性检查了 39 名平均孕龄为 23.6 周的胎儿，这些胎儿患有肾病或尿路畸形，肾功能明显受损或丧失。进行胎儿超声心动图检查，测量室间隔和左右心室壁的厚度。通过彩色多普勒超声获取脐动脉、大脑中动脉和静脉导管的血流速度波形。从胎儿血液样本中测定循环 N 末端 pro-B 型利钠肽（nt-proBNP）、胱抑素 C、β2-微球蛋白和血红蛋白的浓度。
畸形包括 21 例梗阻性尿路病、10 例双侧肾病和 8 例双侧肾发育不全。所有病例均存在明显的双心室心肌肥厚。实测值与胎龄校正正常范围的比值分别为 2.01（室间隔）、1.85 和 1.78（左右心室壁）。与对照组相比，循环 nt-proBNP 水平显著升高（中位数（IQR）5035ng/L（5936ng/L）vs.1874ng/L（1092ng/L）；p<0.001）。胱抑素 C 和β2-微球蛋白浓度分别升高至 1.85±0.391mg/L 和 8.44±2.423mg/L（正常范围分别为 1.66±0.202mg/L 和 4.25±0.734mg/L）。心血管参数与尿路形态和功能之间未检测到相关性。尽管 nt-proBNP 水平升高，但心血管功能仍保持正常，90.2%的病例胎儿多普勒指数正常。
导致严重肾功能损害的尿路畸形与双心室心肌肥厚和胎儿期循环 nt-proBNP 浓度升高有关。心血管发现与肾功能或形态无关。
