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Dolores M Shoback - One of the best experts on this subject based on the ideXlab platform.
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cinacalcet hydrochloride maintains long term normocalcemia in patients with primary hyperparathyroidism
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Munro Peacock, Preston S. Klassen, Matthew Guo, John P Bilezikian, Stewart A Turner, Dolores M ShobackAbstract:Calcimimetics increase the sensitivity of parathyroid calcium-sensing receptors to extracellular calcium, thereby reducing PTH secretion. This multicenter, randomized, double-blind, placebo-controlled study assessed the ability of the oral calcimimetic cinacalcet HCl to achieve long-term reductions in serum calcium and PTH concentrations in patients with primary hyperparathyroidism (HPT). Patients (n = 78) were randomized to cinacalcet or placebo. Cinacalcet was titrated from 30-50 mg twice daily during a 12-wk dose-titration phase. Efficacy was assessed during 12-wk maintenance and 28-wk follow-up phases. The primary endpoint was the achievement of normocalcemia [serum calcium Urine Biochemistry, biochemical measures of bone turnover, bone mineral density, and safety were also assessed. Seventy-three percent of cinacalcet-treated patients vs. only 5% of placebo-treated patients achieved the primary endpoint (P < 0.001). Fasting predose plasma PTH decreased 7.6% in cinacalcet patients but increased 7.7% in placebo patients (P < 0.01). Bone mineral density was unchanged by cinacalcet, but bone resorption and formation markers increased (P < 0.05). Adverse events were mild and similar between treatment groups. Cinacalcet rapidly normalizes serum calcium and reduces PTH in patients with primary HPT, and these effects are maintained with long-term treatment. Cinacalcet may be an effective, nonsurgical approach for management of primary HPT.
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cinacalcet hydrochloride maintains long term normocalcemia in patients with primary hyperparathyroidism
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Munro Peacock, Preston S. Klassen, John P Bilezikian, Stewart A Turner, Dolores M ShobackAbstract:Calcimimetics increase the sensitivity of parathyroid calcium-sensing receptors to extracellular calcium, thereby reducing PTH secretion. This multicenter, randomized, double-blind, placebo-controlled study assessed the ability of the oral calcimimetic cinacalcet HCl to achieve long-term reductions in serum calcium and PTH concentrations in patients with primary hyperparathyroidism (HPT). Patients (n = 78) were randomized to cinacalcet or placebo. Cinacalcet was titrated from 30–50 mg twice daily during a 12-wk dose-titration phase. Efficacy was assessed during 12-wk maintenance and 28-wk follow-up phases. The primary endpoint was the achievement of normocalcemia [serum calcium ≤ 10.3 mg/dl (2.57 mmol/liter)] with at least 0.5 mg/dl (0.12-mmol/liter) reduction from baseline. Plasma PTH, serum and Urine Biochemistry, biochemical measures of bone turnover, bone mineral density, and safety were also assessed. Seventy-three percent of cinacalcet-treated patients vs. only 5% of placebo-treated patients achieve...
Francoise Muller - One of the best experts on this subject based on the ideXlab platform.
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fetal Urine Biochemistry in antenatal bartter syndrome a case report
Clinical Case Reports, 2016Co-Authors: Myriam Rachid, Sophie Dreux, Jeanfrancois Oury, Georges Deschenes, Isabelle Czerkiewicz, Rosa Vargaspoussou, Dominique Mahieucaputo, Francoise MullerAbstract:Bartter syndrome is a severe inherited tubulopathy responsible for renal salt wasting. It is caused by alterations in ion channels located in the thick ascending limb of Henle's loop. Five mutations in four genes – SLC12A1, KCNJ1, CLCNKB, and BSND – coding for transporters and one specific mutation (L125Q) in the CASR gene, which encodes the calcium‐sensing receptor, have been identified 1, 2. First described in 1962 3, two presentations are currently recognized. The classic form develops in childhood and is characterized by severe polyuria, dehydration, hypokalemic metabolic alkalosis, secondary hyper‐aldosteronism, and hypercalciuria sometimes leading to nephrocalcinosis. The second presentation is antenatal, more severe 4, 5 and is revealed by refractory polyhydramnios (caused by fetal polyuria) during the second trimester of pregnancy, without morphological anomalies. The major consequences are preterm birth, growth retardation, and severe dehydration at birth due to salt loss. In children with Bartter syndrome, urinalysis highlights increased sodium, potassium, chloride and calcium excretion, and as a consequence hyponatremia, hypochloremia, and hypokalemia 4, 6. However, until now, no studies have been published about fetal urinalysis in antenatal Bartter syndrome. A 28‐year‐old woman in a consanguineous marriage (first cousins), gravida 1, para 0, presented severe polyhydramnios at routine ultrasound examination at 22.6 weeks of amenorrhea. Megacystis was observed in a female fetus, without any other malformation. After genetic counseling, invasive procedures were offered to the parents and accepted: amniotic fluid sampling for karyotyping and Biochemistry and fetal Urine sampling for renal function evaluation. The karyotype was normal, 46,XX. A second amniocentesis was secondarily performed at 26.3 weeks for amniodrainage. Amniotic fluid alpha‐fetoprotein and total protein were decreased at both 22.6 and 26.3 weeks (Table 1), giving a Bartter index (total protein expressed in g/L x alpha‐fetoprotein in MoM) of 0.85 and 0.71, respectively 7. These values were strongly suggestive of Bartter syndrome. In fetal Urine we assayed electrolytes, beta‐2 microglobulin, and total protein. Results are presented in Table 1 in comparison with two fetal Urine controls (one with renal failure and one with normal renal function, both performed because of megacystis). Electrolytes were significantly increased in Bartter syndrome compared with controls (P < 0.001). A weekly check‐up was planned. The patient delivered a girl at 33.6 weeks of gestation. The baby presented clinical and laboratory signs of Bartter syndrome. Postnatal screening for Bartter syndrome mutations detected a homozygous mutation in the SLC12A1 gene. Table 1 Fetal Urine and amniotic fluid electrolytes (mmol/L), β2‐microglobulin (β2 m), and total protein in Bartter syndrome and controls
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fetal Urine Biochemistry at 13 23 weeks of gestation in lower urinary tract obstruction criteria for in utero treatment
Ultrasound in Obstetrics & Gynecology, 2015Co-Authors: W Abdennadher, G E Chalouhi, Sophie Dreux, Jonathan Rosenblatt, R Favre, F Guimiot, L J Salomon, J F Oury, Y Ville, Francoise MullerAbstract:Objectives To assess the value of fetal Urine Biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in-utero intervention. Methods This was a retrospective study including 72 cases of LUTO with fetal Urine sampled before 23 weeks and assayed for total protein, β-2-microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma-glutamyl transpeptidase (GGTP). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. Results LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU/L vs 5 IU/L; P < 0.0001) were observed in fetal Urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β-2-microglobulin (P = 0.0017), sodium (P = 0.0008), chloride (P = 0.0028) and calcium (P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β-2-microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. Conclusions Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal Urine Biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal Urine Biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
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fetal urinary peptides to predict postnatal outcome of renal disease in fetuses with posterior urethral valves puv
Science Translational Medicine, 2013Co-Authors: Julie Klein, Chrystelle Lacroix, Cecile Caubet, Justyna Siwy, Petra Zurbig, Mohammed Dakna, Francoise MullerAbstract:Bilateral congenital abnormalities of the kidney and urinary tract (CAKUT), although are individually rare diseases, remain the main cause of chronic kidney disease in infants worldwide. Bilateral CAKUT display a wide spectrum of pre- and postnatal outcomes ranging from death in utero to normal postnatal renal function. Methods to predict these outcomes in utero are controversial and, in several cases, lead to unjustified termination of pregnancy. Using capillary electrophoresis coupled with mass spectrometry, we have analyzed the urinary proteome of fetuses with posterior urethral valves (PUV), the prototypic bilateral CAKUT, for the presence of biomarkers predicting postnatal renal function. Among more than 4000 fetal urinary peptide candidates, 26 peptides were identified that were specifically associated with PUV in 13 patients with early end-stage renal disease (ESRD) compared to 15 patients with absence of ESRD before the age of 2. A classifier based on these peptides correctly predicted postnatal renal function with 88% sensitivity and 95% specificity in an independent blinded validation cohort of 38 PUV patients, outperforming classical methods, including fetal Urine Biochemistry and fetal ultrasound. This study demonstrates that fetal Urine is an important pool of peptides that can predict postnatal renal function and thus be used to make clinical decisions regarding pregnancy.
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development of human fetal kidney in obstructive uropathy correlations with ultrasonography and Urine Biochemistry
Kidney International, 1997Co-Authors: Farida Daikhadahmane, Francoise Muller, Marc Dommergues, F Narcy, Mireille Lacoste, A Beziau, Y Dumez, Marieclaire GublerAbstract:Development of human fetal kidney in obstructive uropathy: Correlations with ultrasonography and Urine Biochemistry. In utero urethral obstruction results in bilateral hydronephrosis and severe fetal and post-natal morbidity and mortality. Obstetrical management depends on the indirect evaluation of fetal renal function by ultrasonography and biochemical analysis. No direct evaluation of the severity and possible reversibility of renal lesions is available. In this paper we analyzed kidneys from 34 fetuses (14 to 37 gestational weeks) in which ( 1 ) isolated bilateral urinary tract obstruction had been detected in utero by sonography, and ( 2 ) the severity of sonographic and biochemical prognostic indicators led to the indication of termination of pregnancy or to perinatal death. Pure hydronephrosis was observed in two young fetuses [14 and 20 gestational weeks (GW)] and was associated with regressive changes in two others. In contrast, a wide spectrum of dysplastic renal lesions was present in 30 fetuses and was classified into four subgroups according to the association of dysplasia, hypoplasia and cysts. They had the following characteristics in common: ( 1 ) premature cessation of nephrogenesis assessed by the medullary ray counting method; ( 2 ) early disappearance or myofibroblas-tic differentiation of metanephric blastema; ( 3 ) early increase in interstitial mesenchyme with widespread expression of alpha-smooth muscle actin by mesenchymal cells; ( 4 ) frequent absence of classical criteria of dysplasia (nests of cartilage were observed in only 5 fetuses); ( 5 ) an identification, based upon the detection of alpha-smooth muscle actin expression, of the muscular phenotype of mesenchymal cells encircling primitive ducts. In conclusion, ( 1 ) the value of prognostic markers in fetuses less than 20 GW should be reconsidered; ( 2 ) after 20 GW there is a good correlation between markers predicting poor prognosis and the severity of renal lesions; ( 3 ) hypoplasia with disappearance of blastema cells, dysplasia and early interstitial fibrosis are evidence of the irreversibility of renal lesions and preclude any possibility of new nephron formation; ( 4 ) these findings suggest that most surgical in utero procedures are performed when irreversible renal lesions have developed.
Daniel Vitorio - One of the best experts on this subject based on the ideXlab platform.
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Urine Biochemistry assessment in critically ill patients: controversies and future perspectives
Journal of Clinical Monitoring and Computing, 2017Co-Authors: Alexandre Toledo Maciel, Daniel VitorioAbstract:In the past, Urine Biochemistry was a major tool in acute kidney injury (AKI) management. Classic papers published some decades ago established the values of the Urine indices which were thought to distinguish “pre-renal” (functional) AKI attributed to low renal perfusion and “renal” (structural) AKI attributed to acute tubular necrosis (ATN). However, there were a lot of drawbacks and limitations in these studies and some recent articles have questioned the utility of measuring Urine electrolytes especially because they do not seem to adequately inform about renal perfusion nor AKI duration (transient vs. persistent). At the same time, the “pre-renal” paradigm has been consistently criticized because hypoperfusion followed by ischemia and ATN does not seem to explain most of the AKI developing in critically ill patients and distinct AKI durations do not seem to be clearly related to different pathophysiological mechanisms or histopathological findings. In this new context, other possible roles for Urine Biochemistry have emerged. Some studies have suggested standardized changes in the Urine electrolyte composition preceding increases in serum creatinine independently of AKI subsequent duration, which might actually be due to intra-renal microcirculatory changes and activation of sodium-retaining mechanisms even in the absence of impaired global renal blood flow. In the present review, the points of controversy regarding Urine Biochemistry assessment were evaluated as well as future perspectives for its role in AKI monitoring. An alternative approach for the interpretation of measured Urine electrolytes is proposed which needs further larger studies to be validated and incorporated in daily ICU practice.
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very transient cases of acute kidney injury in the early postoperative period after cardiac surgery the relevance of more frequent serum creatinine assessment and concomitant urinary Biochemistry evaluation
Journal of Cardiothoracic and Vascular Anesthesia, 2016Co-Authors: Alexandre Toledo Maciel, Antonio Paulo Nassar, Daniel VitorioAbstract:Objective To evaluate if more frequent serum creatinine (sCr) measurements in the early postoperative period (first 48 hours) after cardiac surgery would help in early diagnosis of acute kidney injury (AKI), as well as reveal cases of AKI duration of fewer than 24 hours (vtAKI). The sequential blood and urinary biochemical profile of patients who developed vtAKI was compared with that of the patients who did not develop AKI or who developed AKI for more than 48 hours (pAKI). Design A retrospective analysis of prospectively collected data. Setting Two intensive care units of 2 private hospitals. Participants Twenty-nine patients who underwent cardiac surgery who had 6 values of serum creatinine (sCr) measured within the first 48 hours after surgery and concomitant spot Urine samples for Urine Biochemistry assessment. Interventions None. Measurements and Main Results Eighteen patients (62%) developed Acute Kidney Injury Network (AKIN) sCr-based AKI, half of them for fewer than 24 hours. Most AKI patients had the sCr increase diagnosed 6 to 12 hours after surgery. When comparing the sequential alterations of blood and urinary parameters among patients with no AKI, vtAKI, and pAKI, the authors found that most of them were similar among groups, differing only in magnitude and duration. Conclusions More frequent sCr measurements in the early postoperative period, together with Urine Biochemistry assessment, have the potential to anticipate AKI diagnosis after cardiac surgery and reveal cases of very transient AKI usually not diagnosed in current practice. The clinical relevance of these findings must be evaluated in larger, prospective studies.
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Urine Biochemistry in acute kidney injury are we moving in the right direction
Critical Care, 2013Co-Authors: Alexandre Toledo Maciel, Daniel VitorioAbstract:We read with interest the article by Pons and colleagues [1] in a recent issue of Critical Care and we would like to ask them a few questions. They excluded patients ‘for whom Urine could not be collected according to the study protocol’ [1]. What were the reasons for this - anuria, renal replacement therapy (RRT), ICU discharge or death? The authors said that there was no patient receiving RRT at the time of the study, but then they mentioned 14 patients requiring RRT in the first 24 hours. How many patients were excluded due to less than 72 hours of follow-up? Since acute kidney injury (AKI) diagnosis was mandatorily done on admission in order to define AKI reversal in the first 3 ICU days, what about patients who were ‘no-AKI’ on admission but developed AKI in these 3 days? The authors evaluated urinary indices which are actually calculated variables, dependent on multiple measured parameters. In a pilot study [2], we demonstrated that urinary sodium (NaU) was lower on admission in patients who developed AKI in the first 4 ICU days. We believe that sequential NaU measurement is useful, especially in the absence of diuretics, and that early AKI development is characterized by decreases in NaU which may precede increases in creatinine, in both transient and persistent AKI (unpublished data). These findings suggest that transient and persistent AKI are different magnitudes of the same pathophysiological process and not synonyms of functional/structural AKI [3]. This may partially explain the absence of discernment ability of the urinary indices. What was the time course of NaU in your three groups in the absence of diuretics? We believe that there is a role for Urine Biochemistry in AKI assessment and to exclude it from daily practice is the wrong direction.
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Urine Biochemistry in the early postoperative period after cardiac surgery role in acute kidney injury monitoring
Case reports in critical care, 2013Co-Authors: Alexandre Toledo Maciel, Daniel VitorioAbstract:We have recently suggested that sequential Urine electrolyte measurement in critically ill patients may be useful in monitoring kidney function. Cardiac surgery is one of the leading causes of acute kidney injury (AKI) in the intensive care unit (ICU). In this paper, we describe the sequential behavior of Urine electrolytes in three patients in the early (first 60 hours) postoperative period after cardiac surgery according to AKI status: no AKI, transient AKI, and persistent AKI. We have found that the patient with no AKI had stable and high concentrations of sodium (NaU) and chloride (ClU) in sequential spot samples of Urine. AKI development was characterized in the other two patients by decreases in NaU and ClU, which have started early after ICU admission. Transient AKI was marked by also transient and less severe decreases in NaU and ClU. Persistent AKI was marked by the less favorable clinical course with abrupt and prolonged declines in NaU and ClU values. These electrolytes in Urine had a behavior like a “mirror image” in comparison with that of serum creatinine. We suggest that sequential Urine electrolytes are useful in monitoring acute kidney injury development in the early postoperative period after cardiac surgery.
Munro Peacock - One of the best experts on this subject based on the ideXlab platform.
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cinacalcet hydrochloride maintains long term normocalcemia in patients with primary hyperparathyroidism
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Munro Peacock, Preston S. Klassen, Matthew Guo, John P Bilezikian, Stewart A Turner, Dolores M ShobackAbstract:Calcimimetics increase the sensitivity of parathyroid calcium-sensing receptors to extracellular calcium, thereby reducing PTH secretion. This multicenter, randomized, double-blind, placebo-controlled study assessed the ability of the oral calcimimetic cinacalcet HCl to achieve long-term reductions in serum calcium and PTH concentrations in patients with primary hyperparathyroidism (HPT). Patients (n = 78) were randomized to cinacalcet or placebo. Cinacalcet was titrated from 30-50 mg twice daily during a 12-wk dose-titration phase. Efficacy was assessed during 12-wk maintenance and 28-wk follow-up phases. The primary endpoint was the achievement of normocalcemia [serum calcium Urine Biochemistry, biochemical measures of bone turnover, bone mineral density, and safety were also assessed. Seventy-three percent of cinacalcet-treated patients vs. only 5% of placebo-treated patients achieved the primary endpoint (P < 0.001). Fasting predose plasma PTH decreased 7.6% in cinacalcet patients but increased 7.7% in placebo patients (P < 0.01). Bone mineral density was unchanged by cinacalcet, but bone resorption and formation markers increased (P < 0.05). Adverse events were mild and similar between treatment groups. Cinacalcet rapidly normalizes serum calcium and reduces PTH in patients with primary HPT, and these effects are maintained with long-term treatment. Cinacalcet may be an effective, nonsurgical approach for management of primary HPT.
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cinacalcet hydrochloride maintains long term normocalcemia in patients with primary hyperparathyroidism
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Munro Peacock, Preston S. Klassen, John P Bilezikian, Stewart A Turner, Dolores M ShobackAbstract:Calcimimetics increase the sensitivity of parathyroid calcium-sensing receptors to extracellular calcium, thereby reducing PTH secretion. This multicenter, randomized, double-blind, placebo-controlled study assessed the ability of the oral calcimimetic cinacalcet HCl to achieve long-term reductions in serum calcium and PTH concentrations in patients with primary hyperparathyroidism (HPT). Patients (n = 78) were randomized to cinacalcet or placebo. Cinacalcet was titrated from 30–50 mg twice daily during a 12-wk dose-titration phase. Efficacy was assessed during 12-wk maintenance and 28-wk follow-up phases. The primary endpoint was the achievement of normocalcemia [serum calcium ≤ 10.3 mg/dl (2.57 mmol/liter)] with at least 0.5 mg/dl (0.12-mmol/liter) reduction from baseline. Plasma PTH, serum and Urine Biochemistry, biochemical measures of bone turnover, bone mineral density, and safety were also assessed. Seventy-three percent of cinacalcet-treated patients vs. only 5% of placebo-treated patients achieve...
Y Ville - One of the best experts on this subject based on the ideXlab platform.
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Urine Biochemistry to predict long term outcomes in fetuses with posterior urethral valves
Prenatal Diagnosis, 2018Co-Authors: Sophie Dreux, Jonathan Rosenblatt, Amelie Moussydurandy, Franck Patin, Romain Favre, Stephen Lortatjacob, Alaa El Ghoneimi, Jeanfrancois Oury, Georges Deschenes, Y VilleAbstract:OBJECTIVE Because the literature on the predictive value of fetal urinalysis is controversial in fetuses with lower urinary tract obstruction, we determined the best model of fetal Urine biochemical markers correlated with long-term postnatal renal function based on glomerular filtration rate (GFR). METHOD This retrospective study concerned 89 fetuses with lower urinary tract obstruction and their renal function after 10 years of age. We correlated fetal Urine biochemical markers (total protein, β2-microglobulin, sodium, chloride, glucose, calcium, and phosphorus) with GFR at 10 to 30 years of age in 89 patients with posterior urethral valves. We defined five stages of chronic kidney disease (CKD). RESULTS Of the 89 patients, 18 (20%) are 20 years old or over. Postnatal renal function was good in 67.4% (GFR > 60 mL/min/1.73 m2 ) and poor in 17% (GFR < 30 mL/min/1.73 m2 ). All fetal Urine markers differed between CKD stage 1 + 2 and CKD stage 4 + 5 (P < 0.001). β2-microblobulin showed an 87% sensitivity for a 72% specificity. A combination of β2-microglobulin and chloride gave the best results (93% sensitivity and 71% specificity) versus amniotic fluid volume (80% sensitivity and 73% specificity). CONCLUSION Fetal Urine Biochemistry predicts long-term (10-30 years) postnatal renal function.
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fetal Urine Biochemistry at 13 23 weeks of gestation in lower urinary tract obstruction criteria for in utero treatment
Ultrasound in Obstetrics & Gynecology, 2015Co-Authors: W Abdennadher, G E Chalouhi, Sophie Dreux, Jonathan Rosenblatt, R Favre, F Guimiot, L J Salomon, J F Oury, Y Ville, Francoise MullerAbstract:Objectives To assess the value of fetal Urine Biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in-utero intervention. Methods This was a retrospective study including 72 cases of LUTO with fetal Urine sampled before 23 weeks and assayed for total protein, β-2-microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma-glutamyl transpeptidase (GGTP). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. Results LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU/L vs 5 IU/L; P < 0.0001) were observed in fetal Urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β-2-microglobulin (P = 0.0017), sodium (P = 0.0008), chloride (P = 0.0028) and calcium (P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β-2-microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. Conclusions Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal Urine Biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal Urine Biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
