{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:02:50Z","timestamp":1769000570864,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter, retrospective study included male fetuses with severe LUTO which died before 24\u2009weeks of gestation during the period January 2000 to December 2018. Age\u2010matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and\/or urine <jats:italic>\u03b2<\/jats:italic>2microglobulin level were retrieved and kidney histology slides (hematein\u2010eosin\u2010safran and <jats:italic>\u03b1<\/jats:italic>\u2010smooth\u2010muscle\u2010actin (<jats:italic>\u03b1<\/jats:italic>SMA) immunostaining) were prepared and reviewed. <jats:italic>\u03b1<\/jats:italic>SMA\u2010positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and <jats:italic>\u03b1<\/jats:italic>SMA labeling and the data of these groups were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Included in the study were 74 fetuses with a median gestational age at outcome of 17\u2009+\u20096 (range, 13\u2009+\u20090 to 23\u2009+\u20095)\u2009weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and <jats:italic>\u03b1<\/jats:italic>SMA\u2010negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died \u2264\u200918\u2009weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (<jats:italic>P<\/jats:italic>\u2009=\u20090.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early\u2010unfavorable\u2010prognosis group (\u2264\u200918\u2009weeks) and the group with a favorable prognosis (<jats:italic>P<\/jats:italic>\u2009=\u20090.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Before 18\u2009weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23718","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T22:15:38Z","timestamp":1624918538000},"page":"513-521","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-9620","authenticated-orcid":false,"given":"N.","family":"Vinit","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery and Urology Necker\u2010Enfants Malades Hospital  APHP, Paris France"},{"name":"EA FETUS 7328\u2010PACT, Imagine Institute Paris University  Paris 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Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA) Necker\u2010Enfants Malades Hospital  APHP, Paris France"},{"name":"INSERM UMR 1163, Laboratory of Inherited Kidney Diseases Imagine Institute, University of Paris  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.\u2010C.","family":"Gubler","sequence":"additional","affiliation":[{"name":"INSERM UMR 1163, Laboratory of Inherited Kidney Diseases Imagine Institute, University of Paris  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Dreux","sequence":"additional","affiliation":[{"name":"Department of Biochemistry\u2010Hormonology Robert Debr\u00e9 Hospital  APHP, Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Attie\u2010Bitach","sequence":"additional","affiliation":[{"name":"EA FETUS 7328\u2010PACT, Imagine Institute Paris University  Paris France"},{"name":"Department of Histology, Embryology 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