Introduction: Fetal renal failure (FRF) is a challenging antenatal diagnosis associated with insufficient pulmonary development and potential compromise for the future possibility of dialysis and kidney transplantation. Even in cases in which lung development can be fostered by serial amnioinfusions (AIs), infants who are born prematurely may not qualify for peritoneal dialysis due to weight criteria. Methods: We describe our outcomes after introducing an integrated approach at two institutions to prenatal management of FRF with a serial AI protocol and postnatal management with peritoneal dialysis. Our primary endpoint was survival to 6 months of age with successful dialysis, and the secondary outcomes included the ability to transition to renal transplantation. Results: The mean gestational age at which AIs were initiated was 23.3 ± 2.32 weeks for the whole cohort. There was no significant difference between survivors (22.51 ± 1.70 weeks) and non-survivors (23.31 ± 2.69 weeks, p = 0.339) in the gestational age at initiation of AIs. The mean gestational age at delivery for the entire cohort was 34.8 ± 2.62 weeks, and there was a trend toward but did not achieve significance between survivors (35.0 ± 1.60 weeks) compared to non-survivors (33.17 ± 3.34 weeks, p = 0.066). Survival to delivery was 100% for the total AI cohort (n = 30). Conclusion: A total of 83% of patients alive at 48 h survived the neonatal period and of those surviving the neonatal period, 62.5% survived a minimum of 6 months on outpatient peritoneal dialysis (PD). This series also established that PD can be successfully performed in neonates as small as 1,500 g. Four patients have successfully undergone renal transplantation. Serial AIs for FRF offer the potential, not only in neonatal pulmonary survival but also long-term survival to kidney transplantation.

1.
Miller
JL
,
Baschat
AA
,
Atkinson
MA
.
Fetal therapy for renal anhydramnios
.
Clin Perinatol
.
2022
;
49
(
4
):
849
62
.
2.
Ruano
R
,
Safdar
A
,
Au
J
,
Koh
CJ
,
Gargollo
P
,
Shamshirsaz
AA
, et al
.
Defining and predicting ‘intrauterine fetal renal failure’ in congenital lower urinary tract obstruction
.
Pediatr Nephrol
.
2016
;
31
(
4
):
605
12
.
3.
Westland
R
,
Schreuder
MF
,
Ket
JC
,
van Wijk
JA
.
Unilateral renal agenesis: a systematic review on associated anomalies and renal injury
.
Nephrol Dial Transpl
.
2013
;
28
(
7
):
1844
55
.
4.
Atkinson
MA
,
Jelin
EB
,
Baschat
A
,
Blumenfeld
YJ
,
Chmait
RH
,
O’Hare
E
, et al
.
Design and protocol of the renal anhydramnios fetal therapy (RAFT) trial
.
Clin Ther
.
2022
;
44
(
8
):
1161
71
.
5.
Haeri
S
,
Simon
DH
,
Pillutla
K
.
Serial amnioinfusions for fetal pulmonary palliation in fetuses with renal failure
.
J Matern Fetal Neonatal Med
.
2017
;
30
(
2
):
174
6
.
6.
Polzin
WJ
,
Lim
FY
,
Habli
M
,
Van Hook
J
,
Minges
M
,
Jaekle
R
, et al
.
Use of an amnioport to maintain amniotic fluid volume in fetuses with oligohydramnios secondary to lower urinary tract obstruction or fetal renal anomalies
.
Fetal Diagn Ther
.
2017
;
41
(
1
):
51
7
.
7.
Miller
JL
,
Baschat
AA
,
Rosner
M
,
Blumenfeld
YJ
,
Moldenhauer
JS
,
Johnson
A
, et al
.
Neonatal survival after serial amnioinfusions for bilateral renal agenesis: the renal anhydramnios fetal therapy trial
.
JAMA
.
2023
;
330
(
21
):
2096
105
.
8.
Riddle
S
,
Habli
M
,
Tabbah
S
,
Lim
FY
,
Minges
M
,
Kingma
P
, et al
.
Contemporary outcomes of patients with isolated bilateral renal agenesis with and without fetal intervention
.
Fetal Diagn Ther
.
2020
;
47
(
9
):
675
81
.
9.
Habli
M
,
Riddle
S
,
Null
G
,
Peiro
J
,
Hoffman
M
,
Minges
M
, et al
.
Outcome of pregnancies complicated by fetal renal failure (FRF) treated by percutaneous needle amnioinfusions versus amnioport
.
Am J Obstet Gynecol
.
2022
;
226
(
1
):
S49
50
.
10.
Siegler
Y
,
Weiner
Z
,
Solt
I
.
ACOG practice bulletin no. 217: prelabor rupture of membranes
.
Obstet Gynecol
.
2020
;
136
(
5
):
1061
.
11.
Warring
SK
,
Novoa
V
,
Shazly
S
,
Trinidad
MC
,
Sas
DJ
,
Schiltz
B
, et al
.
Serial amnioinfusion as regenerative therapy for pulmonary hypoplasia in fetuses with intrauterine renal failure or severe renal anomalies: systematic review and future perspectives
.
Mayo Clin Proc Innov Qual Outcomes
.
2020
;
4
(
4
):
391
409
.
12.
Bienstock
JL
,
Birsner
ML
,
Coleman
F
,
Hueppchen
NA
.
Successful in utero intervention for bilateral renal agenesis
.
Obstet Gynecol
.
2014
;
124
(
2 Pt 2 Suppl 1
):
413
5
.
13.
Riddle
S
,
Null
G
,
Lim
F
,
Hoffman
M
,
McKinney
D
,
Markham
KB
, et al
.
Serial percutaneous amnioinfusion for pulmonary palliation and neonatal survival in fetal renal failure
.
Am J Obstet Gynecol
.
2022
;
226
(
1
):
S619
20
.
14.
O’Hare
EM
,
Jelin
AC
,
Miller
JL
,
Ruano
R
,
Atkinson
MA
,
Baschat
AA
, et al
.
Amnioinfusions to treat early onset anhydramnios caused by renal anomalies: background and rationale for the renal anhydramnios fetal therapy trial
.
Fetal Diagn Ther
.
2019
;
45
(
6
):
365
72
.
15.
Io
S
,
Kondoh
E
,
Chigusa
Y
,
Tani
H
,
Hamanishi
J
,
Konishi
I
.
An experience of second-trimester anhydramnios salvaged by single amnioinfusion
.
J Med Ultrason
.
2018
;
45
(
3
):
525
7
.
16.
Cheng
JM
,
Baschat
AA
,
Atkinson
MA
,
Rosner
M
,
Kush
ML
,
Wolfson
D
, et al
.
Comparison of serial amnioinfusion strategies for isolated early-onset fetal renal anhydramnios
.
Fetal Diagn Ther
.
2024
;
1
:
1
.
You do not currently have access to this content.