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Meta-analysis and cohort study examine chromosomal copy number variations in fetuses with urinary tract abnormalitiesGenetic screening reveals hidden risks in fetal kidney scans

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Key Takeaway
Consider routine CNV screening for all CAKUT fetuses, particularly non-isolated cases, given pooled incidence findings.

This publication is a meta-analysis and cohort study investigating chromosomal copy number variations in fetuses with ultrasound-detected urinary system anomalies. The cohort included 183 fetuses from the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, northeastern China. The meta-analysis component encompassed 9284 pregnant women.

Chromosomal aneuploidy in conventional karyotyping occurred in 7.41% of cases, representing 12/162 samples. In karyotypically normal cases within the cohort, pathogenic or likely pathogenic copy number variations were found in 7.33%, or 11/150. The weighted pooled incidence of pathogenic or likely pathogenic copy number variations in karyotypically normal CAKUT fetuses across the meta-analysis was 6%, with a 95% CI 0.05-0.07.

Subgroup analysis showed a weighted pooled incidence of 5% for isolated CAKUT with a 95% CI 0.03-0.06. Non-isolated CAKUT fetuses demonstrated a weighted pooled incidence of 8%, with a 95% CI 0.06-0.10. In the cohort study, the difference between isolated and non-isolated cases did not reach statistical significance, with a P = 0.120.

The cumulative crude incidence of pathogenic or likely pathogenic copy number variation in CAKUT fetuses across the meta-analysis was 5.71%, based on 498/8,723 cases. Authors suggest routine copy number variation screening is recommended for all CAKUT fetuses, particularly non-isolated cases, based on findings. Follow-up data spanned from 2017.01-2025.09.

Many parents feel a knot in their stomach when an ultrasound shows something unusual. A dark spot on a kidney or a fluid collection can spark immediate fear. You wonder if this means your baby will face health struggles for years.

This doesn't mean this treatment is available yet.

Kidney issues in babies are more common than most people realize. Doctors call these abnormalities CAKUT. They range from mild shapes to serious blockages. Finding them early helps doctors plan care before birth.

But the old way of checking for genetic problems had limits. Standard tests looked at big chromosome changes. They often missed smaller genetic errors hiding in the DNA code.

What parents see on the ultrasound screen

Imagine your DNA is a factory blueprint for building a body. Small mistakes in the blueprint can cause big problems in the final product. These small mistakes are called copy number variations. They are like missing or extra pages in a manual. A factory worker might skip a step or add a part by accident. This changes how the machine works without breaking the main structure.

The new research looks closely at these pages. It checks if the extra or missing pages match the kidney issues seen on the scan. This method finds problems that standard tests often skip over.

Why genetic testing matters for kidney scans

The study looked at 183 pregnancies in northeastern China. Doctors tracked these cases over nine years. They compared babies with kidney issues to those without genetic errors.

They found that 7.33 percent of babies with normal standard tests still had genetic changes. This number might seem small but it represents many families. It means one in every thirteen babies could have a hidden risk.

Hidden risks found in non-isolated cases

The data showed a clear pattern for babies with multiple issues. Those with kidney problems plus other body changes had higher risks. The rate jumped to over 10 percent in this group. This suggests that when one system fails, others might be involved too.

Babies with only kidney issues had a lower rate. It was around 3 percent in the local study. A larger review of many studies confirmed this trend. Non-isolated cases consistently showed more genetic changes.

But there is a catch. The difference between the groups was not statistically significant in this specific group. This means the numbers could change with more data. It does not mean the risk is the same for everyone.

What happens next for genetic screening

Experts say doctors should test all babies with kidney scans. They should not wait to see if other problems appear. This approach catches more genetic issues early. It helps parents understand the full picture of their baby's health.

The study also found seven genetic changes never seen before in this region. This expands what doctors know about genetic risks in cold climates. It adds to the global list of known genetic markers.

Limitations exist in this research. The study focused on one region in China. Results might differ in other parts of the world. The group size was also relatively small for some subgroups. This means we need more data to be sure.

Future research will need to test these findings in larger groups. Doctors hope to make these tests standard for all prenatal care. Approval processes will take time to ensure safety and accuracy. Global collaboration is key to understanding these genetic risks better.

Parents should talk to their doctors about genetic screening options. Ask if testing is right for your specific situation. Knowledge gives you power to make the best choices for your family.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
OBJECTIVE: To investigate the association between ultrasonically detected fetal urinary system abnormalities and chromosomal copy number variations (CNVs) in Heilongjiang Province, northeastern China. METHODS: Cohort study: 183 fetuses with ultrasound-detected urinary system anomalies (invasive prenatal diagnosis, 2017.01-2025.09, Second Affiliated Hospital of Harbin Medical University) were enrolled. All underwent CNV analysis: 21 without karyotyping, 12 with abnormal karyotypes, 150 with normal karyotypes. The 150 normal-karyotype cases were split into isolated CAKUT (63, 42%) and non-isolated CAKUT (87, 58%) groups; CNV abnormalities were compared between groups. META-ANALYSIS: Studies on CNVs in CAKUT fetuses (2017.01-2025.09) were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, SinoMed. Pooled effect sizes were calculated via Stata 17.0. RESULTS: Among 162 fetuses who underwent conventional karyotyping, chromosomal aneuploidy occurred in 7.41% (12/162). In 150 karyotypically normal cases, pathogenic/likely pathogenic (p/lp) CNVs were detected in 7.33% (11/150): 3.17% (2/63) for isolated CAKUT and 10.34% (9/87) for non-isolated CAKUT (P = 0.120, non-significant). A meta-analysis of 30 studies (9284 pregnant women) demonstrated a weighted pooled incidence of p/lp CNVs of 6% (95% CI 0.05-0.07) in karyotypically normal CAKUT fetuses, with weighted pooled incidences of 5% (95% CI 0.03-0.06) for isolated CAKUT and 8% (95% CI 0.06-0.10) for non-isolated CAKUT. CONCLUSIONS: This is the first cohort study utilizing nine-year data from Heilongjiang Province, a cold region in northeastern China, to analyze the association between fetal urinary system anomalies and CNVs. In this region, the incidence of p/lp CNVs among CAKUT fetuses with normal karyotypes was 7.33%. Notably, seven pathogenic CNV fragments (deletions at 4p15.31, 5p13.1, 15q11.2, 16p11.2, Xq28, and Xp22.31; duplication at 11q15.5) previously unreported in Northeast China were identified, expanding the genetic spectrum associated with CAKUT in cold regions. The meta-analysis noted that the cumulative crude incidence of p/lp CNV in CAKUT fetuses was 5.71% (498/8,723) across all included studies. Both the cohort study and the meta-analysis showed a numerically higher incidence of p/lp CNVs in non-isolated CAKUT compared with isolated cases (10.34% vs. 3.17%, P = 0.120; 8% vs. 5% weighted pooled incidences from the meta-analysis, respectively), though this difference did not reach statistical significance in the cohort study. Thus, routine CNV screening is recommended for all CAKUT fetuses, particularly non-isolated cases, to comprehensively exclude genetic abnormalities, guiding clinical prenatal diagnosis and genetic counseling.
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