Anhydramnios in the setting of severe malformations of the fetal kidney and urinary tract is associated with a high incidence of stillbirths and life-threatening complications, including severe pulmonary hypoplasia, umbilical cord compression, and perinatal asphyxia. To prevent such adverse outcomes, some centers in the United States and elsewhere are offering amniotic fluid restoration for women diagnosed with anhydramnios in the setting of fetal renal malformations. The procedures include infusions of amniotic fluid substitutes (normal saline), percutaneously or through an amnioport—an implanted system for serial or continuous infusion of normal saline to maintain the desired amniotic fluid volume. The procedures are intended to prevent pulmonary hypoplasia and allow the pregnancy to progress closer to term gestation, enabling postnatal renal management, including long-term dialysis and renal transplantation. However, these procedures have not been recommended as standard of care by the professional societies because there are many knowledge gaps, including few data on short-term and long-term renal outcomes. The available diagnostic methods do not provide reliable prognostic information, and the current maternal and fetal interventions have not been standardized. To address these unresolved issues and to propose a research agenda, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Diabetes and Digestive and Kidney Diseases invited a panel of experts to a workshop in August 2016. This report provides a summary of that meeting.
This National Institutes of Health workshop summary provides an overview of the pathophysiology and management of anhydramnios secondary to renal malformations, with an emphasis on research gaps.
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.
Corresponding author: Marva Moxey-Mims, MD, FASN, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC 20010; email: email@example.com.
The workshop held August 8, 2016, was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. No commercial entities supported the workshop.
Financial Disclosure The authors did not report any potential conflicts of interest.
The summary is based on the presentations and discussions at the National Institutes of Health workshop on August 8, 2016, by the invited speakers and panel members listed in Appendix 1, available online at http://links.lww.com/AOG/B95.
The opinions expressed in this paper are those of the presenters at the workshop and those of the authors. They do not reflect official opinions of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, Health and Human Services, or the U.S. federal government.
Each author has indicated that he or she has met the journal's requirements for authorship.