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Can measurement of the foetal renal parenchymal thickness with ultrasound be used as an indirect measure of nephron number?

Part of: Advance Imaging in DOHaD

Published online by Cambridge University Press:  15 April 2020

Sonja Brennan Open the ORCID record for Sonja Brennan [Opens in a new window] ,
David Watson ,
Michal Schneider ,
Donna Rudd  and
Yogavijayan Kandasamy
Sonja Brennan*
Affiliation:
Ultrasound Department, The Townsville Hospital, Douglas, Townsville, Australia College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
David Watson
Affiliation:
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, The Townsville Hospital, Townsville, Australia
Michal Schneider
Affiliation:
Department of Medical Imaging & Radiation Sciences, Monash University, Melbourne, Australia
Donna Rudd
Affiliation:
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
Yogavijayan Kandasamy
Affiliation:
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia Department of Neonatology, The Townsville Hospital, Townsville, Australia Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia
*
Address for correspondence: Sonja Brennan, Ultrasound Department, The Townsville Hospital, IMB 47, P.O. Box 670, Douglas, Townsville, QLD4810, Australia. Email: sonja.brennan@my.jcu.edu.au; sonja.brennan@health.qld.gov.au
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Abstract

Chronic kidney disease continues to be under recognised and is associated with a significant global health burden and costs. An adverse intrauterine environment may result in a depleted nephron number and an increased risk of chronic kidney disease. Antenatal ultrasound was used to measure the foetal renal parenchymal thickness (RPT), as a novel method to estimate nephron number. Foetal renal artery blood flow was also assessed. This prospective, longitudinal study evaluated the foetal kidneys of 102 appropriately grown and 30 foetal growth-restricted foetuses between 20 and 37 weeks gestational age (GA) to provide vital knowledge on the influences foetal growth restriction has on the developing kidneys. The foetal RPT and renal artery blood flow were measured at least every 4 weeks using ultrasound. The RPT was found to be significantly thinner in growth-restricted foetuses compared to appropriately grown foetuses [likelihood ratio (LR) = 21.06, P ≤ 0.0001] and the difference increases with GA. In foetuses with the same head circumference, a growth-restricted foetus was more likely to have a thinner parenchyma than an appropriately grown foetus (LR = 8.9, P = 0.0028), supporting the principle that growth-restricted foetuses preferentially shunt blood towards the brain. No significant difference was seen in the renal arteries between appropriately grown and growth-restricted foetuses. Measurement of the RPT appears to be a more sensitive measure than current methods. It has the potential to identify infants with a possible reduced nephron endowment allowing for monitoring and interventions to be focused on individuals at a higher risk of developing future hypertension and chronic kidney disease.

Keywords

Renal parenchymafoetal renal arteryfoetal growth restrictionnephron numberultrasound
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 12 , Issue 2 , April 2021 , pp. 184 - 192
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Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

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