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VP20.15: Fetal urinary beta‐2 microglobulin and survival in fetal obstructive uropathy in a Latin American setting

Objectives: To describe, through serial vesicocentesis, the longitudinal profile of fetal urine concentration of beta-2 microglobulin (B2M) in lower urinary tract obstruction and fetal survival in a Latin American setting. Methods: A multicentre clinical study in Venezuela and Peru was conducted between 2015–2020, which included 20 cases of pregnancies between 16 to 26 weeks of gestation with diagnosis of fetal obstructive uropathy and normal fetal karyotype. Two vesicocentesis were performed in each patient: the first one at the time of diagnosis, and the second one, 72 hours after the first one. B2M was measured using commercially available assay in both vesicocentesis. All cases had oligo/anhydramnios and bilateral pyelectasia with no renal dysplasia. Vesicoamniotic shunting (VAS) was performed in all of them. Results: B2M concentration was >6mg/L in 65% (13/20) of cases in the first vesicocentesis. Of these, 46.3% (6/13) had B2M concentration <6mg/L in the second vesicocentesis. The average decrease in B2M concentration was 2.84 mg/L for cases with initial B2M >6 mg/L; and B2M concentration decreased 1.76mg/L in cases with initial B2M <6mg/L. There was no survival in those fetuses with urinary B2M more than 6mg/L after the second vesicocentesis. In those fetuses that had B2M less than 6mg/L in the second vesicocentesis, there was no survival when the value of B2M was between 5–6mg/L (5 cases) and there was 50% survival when the value was below 5mg/L (4 out of 8 cases). Conclusions: In severe lower urinary tract obstruction, fetal survival is poor even when beta-2 microglobulin is less than 6mg/L in the second vesicocentesis.