Arantes Rodrigo R, Aguiar Marcos B, Cunha Keyla C C M S, Amaral Arthur A, Melo José Renato O, Vieira Beatriz Chaves C, Colosimo Enrico A, Oliveira Eduardo A, Simoes E Silva Ana Cristina
Division of Genetics, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, Brazil.
Pediatr Nephrol. 2025 Aug 9. doi: 10.1007/s00467-025-06922-y.
We aimed to investigate predictive factors associated with perinatal and neonatal mortality in cases with congenital anomalies of the kidney and urinary tract (CAKUT).
This study included a cohort of neonates with CAKUT born at a tertiary hospital between 1996 and 2021. Controls were matched with CAKUT cases by sex, time, and place of birth at a ratio of approximately 2:1. The covariates included in the analysis were sex, gestational age, birth weight, neonatal classification, and birth order. CAKUT was categorized into four phenotypes: urinary tract dilatation, lower urinary tract obstruction (LUTO), cystic diseases, and agenesis/hypodysplasia. The primary outcome was perinatal and neonatal mortality. Survival analysis was performed using the Cox proportional hazards model.
857 cases and 1,755 controls were included in the analysis. The overall early mortality rate was 7.2%. After controlling for confounding factors, CAKUT cases exhibited a higher risk of perinatal and neonatal mortality than controls (hazard ratio [HR], 25.1; 95%CI, 14.0-45.2). The following covariates were independently associated with mortality: prematurity (HR, 1.7; 95%CI, 1.2-2.5), LBW (HR, 2.4; 95%CI, 1.6-2.5), VLBW (HR, 2.9; 95%CI, 1.1-1.7), oligohydramnios (HR, 3.2; 95%CI, 2.2-4.8), cystic diseases (HR, 3.8; 95%CI, 2.3-6.4), LUTO (HR, 5.1; 95%CI, 3.0-8.5), kidney agenesis/hypodysplasia (HR, 5.1; 95%CI, 2.9-8.7), and extra-renal malformations (HR, 2.6; 95% CI, 1.7-3.9).
CAKUT was associated with elevated stillbirth and neonatal mortality rates compared with controls. Prematurity, LBW, oligohydramnios, extra-renal malformations, and specific CAKUT phenotypes with kidney involvement were associated with increased mortality risk.
我们旨在研究先天性肾脏和尿路畸形（CAKUT）病例中与围产期和新生儿死亡率相关的预测因素。
本研究纳入了1996年至2021年在一家三级医院出生的患有CAKUT的新生儿队列。对照组按性别、时间和出生地点与CAKUT病例以约2:1的比例进行匹配。分析中纳入的协变量包括性别、胎龄、出生体重、新生儿分类和出生顺序。CAKUT分为四种表型：尿路扩张、下尿路梗阻（LUTO）、囊性疾病和肾发育不全/发育不良。主要结局是围产期和新生儿死亡率。使用Cox比例风险模型进行生存分析。
分析纳入了857例病例和1755例对照。总体早期死亡率为7.2%。在控制混杂因素后，CAKUT病例的围产期和新生儿死亡风险高于对照组（风险比[HR]，25.1；95%置信区间，14.0 - 45.2）。以下协变量与死亡率独立相关：早产（HR，1.7；95%置信区间，1.2 - 2.5）、低出生体重（HR，2.4；95%置信区间，1.6 - 2.5）、极低出生体重（HR，2.9；95%置信区间，1.1 - 1.7）、羊水过少（HR，3.2；95%置信区间，2.2 - 4.8）、囊性疾病（HR，3.8；95%置信区间，2.3 - 6.4）、LUTO（HR，5.1；95%置信区间，3.0 - 8.5）、肾发育不全/发育不良（HR，5.1；95%置信区间，2.9 - 8.7）和肾外畸形（HR，2.6；95%置信区间，1.7 - 3.9）。
与对照组相比，CAKUT与死产率和新生儿死亡率升高相关。早产、低出生体重、羊水过少、肾外畸形以及涉及肾脏的特定CAKUT表型与死亡风险增加相关。
