CHSJ

Curr Health Sci J, vol. 42, no. 1, 2016

Fetal Kidneys Ultrasound Appearance in the First Trimester - Clinical Significance and Limits of Counseling

[Original Paper]

S. TUDORACHE(1), M.L. CARA(2), D.G. ILIESCU(1), A. STOICA(3), C. SIMIONESCU(4), L. NOVAC(5), D. CERNEA(6)


(1)University of Medicine and Pharmacy of Craiova, Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency Hospital, Craiova, Romania;
(2)University of Medicine and Pharmacy of Craiova, Public Health Department, Craiova, Romania;
(3)University of Medicine and Pharmacy of Craiova, Pediatric Surgery, Craiova, Romania;
(4)University of Medicine and Pharmacy of Craiova, Pathology Department, Craiova, Romania;
(5)University of Medicine and Pharmacy of Craiova, Obstetrics and Gynecology, Craiova, Romania;
(6)University of Medicine and Pharmacy of Craiova, Anaesthesiology and Intensive Care Department, Craiova, Romania


Abstract:

Objective. The objective of this study was to determine the visualizing rate of fetal kidneys at various gestational ages in late first trimester (FT) and to establish the clinical significance of their two-dimensional ultrasound (2DUS) appearance in the FT. Methods. In a prospective cross-sectional study, 1456 women from an unselected population underwent a detailed assessment of fetal anatomy at 11+0 -13+4 weeks of gestation with the use of transabdominal sonography. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in 1331 cases. Results. 44 cases in which a congenital kidney disease was detected by ultrasound in the prenatal period were identified. The renal pathology was suspected in the FT in 8 cases, and confirmed by a standard test (postmortem autopsy or second-trimester scan) in 4 cases. The standard detailed second-trimester scan at 18-22 weeks diagnosed another 23 cases but refuted suspicion in 4 FT positive cases. The third trimester added another 17, all confirmed by the postpartum scan. For FT presence or absence of congenital renal anomalies, sensitivity, specificity, +LRs and -LRs of 2DUS were 9.09%, 99.69%, 29.25, and 0.91. Conclusion. FT prenatal kidneys’ visualization is critically dependent on the gestational age. FT diagnosis holds uncertainty. An early diagnosis carries a risk of providing a false-positive or a false-negative result, because the differentiation of the renal system is delayed or the diagnosis is not amenable yet to prenatal ultrasound. No FT findings can exclude the mid-trimester follow-up ultrasound scan. Second and third trimester scan are relevant for congenital kidney diseases.


Keywords: first trimester ultrasound, first trimester anomaly scan, fetal kidneys, multicystic dysplastic kidney, polycystic kidney disease, prenatal counseling



Corresponding: Corresponding Author: Stefania Tudorache, University of Medicine and Pharmacy Craiova, Obstetrics and Gynecology, Prenatal Diagnostic Unit, University Emergency Hospital, Craiova, Romania, Petru Rares Street, No 2-4, 200345 Craiova, Romania; e-mail: stefania.tudorache@gmail.com


DOI 10.12865/CHSJ.42.01.03 - Download PDF
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