Introduction:
Diseases of the kidney and urinary tract contribute to approximately 850,000 deaths every year and 115,010,107 disability adjusted life years. CAKUT constitute the major cause of kidney failure in first 3 decades of life. Late diagnosis & catastrophic presentation is often the rule in in CAKUT, though timely detection and intervention will definitely change the outcome. There is dearth of data on the incidence and prevalence of CAKUT as well as its long-term impact in Indian children. We are launching a novel program for early detection and intervention in antenatally detected CAKUT, starting surveillance in utero, continuing postnatally, in infancy and beyond. The software for recruitment and follow up of babies from the entire state is developed by the National Health Mission. Pediatric Renal Assessment, Treatment and Intervention in Kerala State (PRATIKSHA meaning HOPE), provide a data base of CAKUT for the entire state. The prelaunch pilot project was run for a year at our center. We are presenting the clinical profile and short-term outcome in babies with CAKUT recruited at birth from a tertiary care center in south India
Objectives
A prospective observational study was done to analyze the etiology and short-term outcome of antenatally detected kidney anomalies in babies born at our institution who are registered in the program.
Methods:
Babies with kidney anomalies detected on antenatal ultrasound were recruited prospectively from September 2023 to August 2024. UTD classification and SFU grading system was followed. Risk categorization was done based on the severity and laterality of the structural abnormality to high risk, intermediate risk and low risk. Evaluation, medical/surgical interventions and follow up were done as per the existing guidelines. Outcome was assessed at 1 month, 3 months, 6 months and 1 year. Outcome measures included growth, hypertension, proteinuria, acidosis and eGFR. A good kidney outcome was defined as GFR is > 60ml/1.73 m2/minute, with no hypertension, proteinuria or acidosis and growth is above 5th Percentile. Poor outcome is when GFR is below 60ml/minute with or without proteinuria/hypertension/acidosis and growth is below 5th percentile.
Results:
The study population comprised 179 babies ,2.39 % of all deliveries that year (7489). Mean age of mothers was 25.5±0.32. M:F ratio 4.9:1. Mean birth weight was 2693 ± 150 gm. 83.2% babies belong to low risk,10.6% intermediate risk and 6.1% high risk category. Mean follow up was 8 ± 4 months. Hydronephrosis was the commonest abnormality. 60.8% (105) had transient hydronephrosis. Of the high risk and intermediate risk 16.7% (30) babies, PUJ obstruction constituted 33%,16.6% had bilateral VUR and PUV in 6.3% . Renal Hypo dysplasia was seen in 20%. Surgical intervention was done in 8 babies, pyeloplasty in six and PUV fulguration in two.12.6% babies had GFR below 60 ml/mt and 16.6% had acidosis. Growth was below 5th percentile in 12.6%. One baby with renal hypodysplasia and normal eGFR died at three months due to severe pneumonia.
Conclusions:
“PRATIKSHA” is a model for CAKUT Assessment, Treatment and Intervention to optimize the outcome. Timely intervention and follow up is required in antenatally detected kidney anomalies. Identifying and categorizing all babies born with CAKUT and providing optimum care in a streamlined fashion using a software program is possible with " PRATIKSHA". Majority of babies had low risk anomalies. Intermediate and high risk babies in our cohort were given timely optimum care and periodic follow up.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.