Serum β2-microglobulin in fetuses with urinary tract anomalies

Objective: Our purpose was to establish a reference range of fetal serum β2-microglobulin, an index of glomerular filtration rate, and to compare the values obtained in fetuses with urinary tract anomalies with this range. Study design: Serum β2-microglobulin was measured in 53 control fetuses at 18 to 39 weeksʹ gestation and in 14 fetuses with urinary tract anomalies, 9 of which had simultaneous urine sampling. Results: In controls fetal serum β2-microglobulin had a mean value of 3.4 mg/L (95% data intervals 2.0 to 4.9) and did not correlate with gestational age. In the 14 fetuses with urinary tract anomalies β2-microglobulin levels were increased overall compared with controls (median Z score 1.7, range −0.1 to 9.2), and this was also the case in the five fetuses with unilateral renal disorders (median Z score 1.7, range −0.1 to 3.8) and in a fetus who underwent vesicoamniotic shunting and had normal renal function at birth. Serum β2-microglobulin was normal in 4 fetuses with bilateral urinary tract obstruction and normal function at postnatal follow-up and also in 1 of 5 fetuses with renal failure. In fetuses with bilateral uropathy urinary sodium correlated with serum β2-microglobulin levels. Conclusions: Increased values of serum β2-microglobulin in fetuses with urinary tract anomalies indicate an impaired glomerular filtration rate. The finding of raised concentrations in fetuses with unilateral damage suggests that the compensatory role of the normal kidney is not complete during intrauterine life. Larger series are required to ascertain whether fetal blood sampling is warranted in the antenatal investigation of renal function, especially in view of the close correlation between urinary sodium and serum β2-microglobulin levels in fetuses with bilateral obstruction.