Use of urinary beta-2-microglobulin to predict severe renal damage in fetal obstructive uropathy.

PURPOSE

Establish a clinically relevant threshold for urinary beta 2-microglobulin (beta 2m) to predict the presence of several renal damage in fetuses with obstructive uropathies.

METHODS

Retrospective review was conducted of urinary beta 2m levels, clinical outcomes, and pathological findings in 36 fetuses evaluated for presumed obstructive uropathy. Patients were divided into those free of renal injury (group 1, n = 13) and those with clinical or pathological evidence of severe irreversible renal injury (group 2, n = 23).

RESULTS

Including all patients, a threshold beta 2m value of > 6 was able to predict the presence of severe renal damage with a 83% sensitivity and 71% specificity. beta 2m levels tended to decrease with increasing gestational age among those patients without renal injury (group 1), while beta 2m levels increased among those with severe renal damage (group 2). There was no difference in mean beta 2m levels in those < 20 weeks (p = 0.065) while there was a high degree of difference in those > 20 weeks of gestation (p < 0.001). In those > 20 weeks, a threshold of > 10 predicted the presence of severe renal damage with 100% sensitivity and specificity.

CONCLUSIONS

Urinary beta 2m, especially in the fetus > 20 weeks, may be a clinically useful marker to detect the presence of severe renal damage due to obstructive uropathy and thus be an important adjuvant in the proper selection of fetuses for antenatal intervention.