Etiology and management of early pregnancy renal anhydramnios: Is there a place for serial amnioinfusions?

Early pregnancy renal anhydramios (EPRA) comprises congenital renal disease that results in fetal anhydramnios by 22 weeks of gestation. It occurs in over 1 in 2000 pregnancies and affects 1500 families in the US annually. EPRA was historically considered universally fatal due to associated pulmonar...

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Bibliographic Details
Published in:Prenatal diagnosis 2020-04, Vol.40 (5), p.528-537
Main Authors: Jelin, Angie C., Sagaser, Katelynn G., Forster, Katherine R., Ibekwe, Tochi, Norton, Mary E., Jelin, Eric B.
Format: Article
Language:English
Subjects:
Anomalies
Case reports
Diagnosis
DNA microarrays
Etiology
Fetuses
Genetic screening
Gestation
Hypoplasia
Karyotypes
Kidney diseases
Management
Neonates
Pregnancy
Renal failure
Respiratory function
Therapy
Ultrasound
Urinary tract
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Summary:Early pregnancy renal anhydramios (EPRA) comprises congenital renal disease that results in fetal anhydramnios by 22 weeks of gestation. It occurs in over 1 in 2000 pregnancies and affects 1500 families in the US annually. EPRA was historically considered universally fatal due to associated pulmonary hypoplasia and neonatal respiratory failure. There are several etiologies of fetal renal failure that result in EPRA including bilateral renal agenesis, cystic kidney disease, and lower urinary tract obstruction. Appropriate sonographic evaluation is required to arrive at the appropriate urogenital diagnosis and to identify additional anomalies that allude to a specific genetic diagnosis. Genetic evaluation variably includes karyotype, microarray, targeted gene testing, panels, or whole exome sequencing depending on presentation. Patients receiving a fetal diagnosis of EPRA should be offered management options of pregnancy termination or perinatal palliative care, with the option of serial amnioinfusion therapy offered on a research basis. Preliminary data from case reports demonstrate an association between serial amnioinfusion therapy and short‐term postnatal survival of EPRA, with excellent respiratory function in the neonatal period. A multicenter trial, the renal anhydramnios fetal therapy (RAFT) trial, is underway. We sought to review the initial diagnosis ultrasound findings, genetic etiologies, and current management options for EPRA.
ISSN:0197-3851
1097-0223
DOI:10.1002/pd.5658