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. 2025 Aug 9.
doi: 10.1007/s00467-025-06922-y. Online ahead of print.

Risk factors for perinatal and neonatal mortality in cases with congenital anomalies of the kidney and urinary tract: a nested cohort study

Rodrigo R Arantes  1 , Marcos B Aguiar  1 , Keyla C C M S Cunha  2 , Arthur A Amaral  2 , José Renato O Melo  2 , Beatriz Chaves C Vieira  2 , Enrico A Colosimo  3 , Eduardo A Oliveira  4 , Ana Cristina Simoes E Silva  5
Affiliations

Risk factors for perinatal and neonatal mortality in cases with congenital anomalies of the kidney and urinary tract: a nested cohort study

Rodrigo R Arantes et al. Pediatr Nephrol. .

Abstract

Background: We aimed to investigate predictive factors associated with perinatal and neonatal mortality in cases with congenital anomalies of the kidney and urinary tract (CAKUT).

Methods: This study included a cohort of neonates with CAKUT born at a tertiary hospital between 1996 and 2021. Controls were matched with CAKUT cases by sex, time, and place of birth at a ratio of approximately 2:1. The covariates included in the analysis were sex, gestational age, birth weight, neonatal classification, and birth order. CAKUT was categorized into four phenotypes: urinary tract dilatation, lower urinary tract obstruction (LUTO), cystic diseases, and agenesis/hypodysplasia. The primary outcome was perinatal and neonatal mortality. Survival analysis was performed using the Cox proportional hazards model.

Results: 857 cases and 1,755 controls were included in the analysis. The overall early mortality rate was 7.2%. After controlling for confounding factors, CAKUT cases exhibited a higher risk of perinatal and neonatal mortality than controls (hazard ratio [HR], 25.1; 95%CI, 14.0-45.2). The following covariates were independently associated with mortality: prematurity (HR, 1.7; 95%CI, 1.2-2.5), LBW (HR, 2.4; 95%CI, 1.6-2.5), VLBW (HR, 2.9; 95%CI, 1.1-1.7), oligohydramnios (HR, 3.2; 95%CI, 2.2-4.8), cystic diseases (HR, 3.8; 95%CI, 2.3-6.4), LUTO (HR, 5.1; 95%CI, 3.0-8.5), kidney agenesis/hypodysplasia (HR, 5.1; 95%CI, 2.9-8.7), and extra-renal malformations (HR, 2.6; 95% CI, 1.7-3.9).

Conclusions: CAKUT was associated with elevated stillbirth and neonatal mortality rates compared with controls. Prematurity, LBW, oligohydramnios, extra-renal malformations, and specific CAKUT phenotypes with kidney involvement were associated with increased mortality risk.

Keywords: Congenital anomalies of the kidney and urinary tract; Lower urinary tract obstruction; Neonatal mortality; Urinary tract dilation.

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Conflict of interest statement

Declarations. Ethical statement/Ethical approval: This study was approved by the Ethics Committee of Universidade Federal de Minas Gerais (UFMG)—Brazil under the protocol 7.333.449 and followed the principles of the Declaration of Helsinki. Conflict of interest: None declared.

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