Congenital (antenatal) hydronephrosis-modifiable risk factor for chronic kidney disease in children: interdisciplinary approach to prevention of chronic disease. Bibliographical review and the Authors’ own data

Abstract

Congenital hydronephrosis (CHN) is the most common malformation of the kidney which leads to the development of chronic kidney disease (CKD) in children up to its terminal stage. Current clinical practices related to observation and analysis of long-term outcome of the disease and interdisciplinary collaboration are in the need for further improvement. The purpose of the research was to determine whether CHN is a modifiable risk factor for the onset and progression of CKD in children. Materials and methods used: a single-center cohort retrospective study of the results of antenatal screening of fetuses with congenital defects of organs and systems both with CAKUT syndrome and CHN was conducted at the Samara Oblast Regional Clinical Hospital named after V.D. Seredavin (Samara, Russia) in 2013-2022. Results: 13,484 fetuses were registered with congenital malformations of organs and systems, of which 2,818 (20.9% [20.2%; 21.6%]) with those of urinary organs. 390 were born alive with CHN (13.8% [12.6%; 15.2%]), of which 359 (92%) had surgical intervention using Heinz-Andersen method at the age of 37 [0.3-44.5] weeks: 208 (58%) boys/151 (42%), girls; unilateral CHN in 345 (96%) and bilateral in 14 (4%). Recovery occurred in 328 (91.4% [88.0%; 93 ,9%]) cases with CHN after the surgery. Based on the results of the research, an algorithm for interdisciplinary interaction of healthcare specialists was developed for routing of the pregnant women with fetal CAKUT syndrome. Conclusion: CHN is a modifiable risk factor for the development of CKD since 91.4% of children recovered in the long term.