Antenatal oligohydramnios of renal origin: long-term outcome

Background. Prognosis of fetuses with renal oligohydramnios (ROH) is often still regarded as poor. Neonatal complications and the long-term follow-up of fetuses with ROH in two pediatric centres are described. Method. 23 fetuses (16 males, 7 females) were included as patients. Primary diseases included congenital anomalies of the kidney and urinary tract (n = 16), autosomal recessive polycystic kidney disease (n = 4) and renal tubular dysgenesis (n = 3). The analysis includes retrospective chart review. Results. Seven children died (30%), the majority (n = 4, 17%) within the neonatal period due to pulmonary hypoplasia and renal insufficiency. Fourteen patients (61%) required postnatal mechanical ventilation for a median of 4 (range 1-60) days; 11 infants had an associated pneumothorax. All 16 surviving children have chronic kidney disease (CKD) at a current median age of 5.7 years (range 0.5-14.5), managed conservatively in eight patients [median glomerular filtration rate 51 (range 20-78) ml/min/1.73 m2]. Eight patients reached end-stage renal disease at a median age of 0.3 years (range 2 days to 8.3 years), including one patient with pre-emptive kidney transplantation. Five of the patients requiring dialysis underwent successful renal transplantation at a median age of 3.5 years (range 2.5-4). Growth was impaired in seven children requiring growth hormone treatment. Cognitive and motor development was normal in 12 (75%) of the 16 patients and showed a delay in four children, including two with associated syndromal features. Conclusion. ROH is not always associated with a poor prognosis and long-term outcome in survivors is encouraging. The high incidence of neonatal complications and long-term morbidity due to CKD requires a multidisciplinary management of these childre

Methods for measuring arctic and alpine shrub growth:a review

Shrubs have increased in abundance and dominance in arctic and alpine regions in recent decades. This often dramatic change, likely due to climate warming, has the potential to alter both the structure and function of tundra ecosystems. The analysis of shrub growth is improving our understanding of tundra vegetation dynamics and environmental changes. However, dendrochronological methods developed for trees, need to be adapted for the morphology and growth eccentricity of shrubs. Here, we review current and developing methods to measure radial and axial growth, estimate age, and assess growth dynamics in relation to environmental variables. Recent advances in sampling methods, analysis and applications have improved our ability to investigate growth and recruitment dynamics of shrubs. However, to extrapolate findings to the biome scale, future dendroecological work will require improved approaches that better address variation in growth within parts of the plant, among individuals within populations and between species