Perinatal and infant outcome in prenatally diagnosed hyperec
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Hyperechogenic kidneys are a relatively rare antenatal finding, but they generate significant parental anxiety due to uncertain prognosis. 316 fetuses were identified, mostly bilateral, at a mean gestation of 21weeks. The hyperechogenic kidneys were associated with other renal tract abnormalities in 36%, extrarenal structural abnormalities in 32%, abnormal karyotype in 22%, and genetic disease in 15% of cases.

139 fetuses did not survive, with 105 terminations of pregnancy (TOP), 5 intrauterine demise (IUD), and 29 early neonatal deaths (NND). The vast majority had complex pathology: only 4% (6/139) had solely hyperechogenic kidneys, 28% (39/139) had multiple renal tract abnormalities alongside hyperechogenic kidneys and over two-thirds had extra renal abnormalities (94/139).

177 of 316 cases survived after the first month of life with outcome data available in 126 cases. Of these 126 babies, identified 3 groups: half had just isolated hyperechogenic kidneys, 56 had other renal structural abnormalities and 10 had additional extrarenal abnormalities. Considering renal outcome alone, kidney function was abnormal in 13, 10 and 0 infants in these three groups respectively, although concurrent pathology clearly affected the global outcome in the more complex cases. Neonatal mortality of 1.64% was observed in the isolated renal hyperechogenicity group.

Hyperechogenic kidneys are often complicated by other renal tract and extrarenal abnormalities, aberrant karyotype, and genetic disease, and these factors have more of an effect on overall outcome than kidney echogenicity. The renal outcome is good in isolated hyperechogenic kidneys, with 79% having a normal renal function. Importantly, for prognostic counseling, all of the children in our non selected series with isolated echogenic kidneys and normal amniotic fluid levels had a normal renal outcomes in infancy.


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