Factors Determining a Recommendation for Termination of Pregnancy in the Presence of Fetal Renal Anomalies

Background/Objectives: To identify the clinical factors associated with a multidisciplinary fetal council’s recommendation for termination of pregnancy in fetuses with renal anomalies, to describe how often families followed this recommendation, and to describe outcomes among continued pregnancies. Methods: This retrospective cohort study included 103 singleton pregnancies with a prenatally diagnosed renal or urinary tract anomaly discussed at a tertiary fetal council between December 2023 and July 2026. Renal severity, gestational age at diagnosis, amniotic fluid status, associated fetal abnormalities, and genetic evaluation were examined in relation to the council recommendation. Independent associations were assessed using multivariable logistic regression, Poisson regression with robust variance estimation, and Firth penalized logistic regression. Postnatal outcomes were summarized for pregnancies that continued. Results: A termination recommendation was issued in 59 of 103 pregnancies (57.3%). Of these, 43 families (72.9%) accepted it and the pregnancy was terminated, whereas 16 (27.1%) continued the pregnancy. Later diagnosis and moderate or low renal severity were independently associated with a lower likelihood of a termination recommendation. The presence of an additional fetal anomaly (adjusted odds ratio [aOR] 8.24, 95% confidence interval [CI] 1.59–42.65) and completion of genetic testing (aOR 4.53, 95% CI 1.45–14.15) were independently associated with a higher likelihood of such a recommendation. Among 60 continued pregnancies, 11 intrauterine or neonatal/postnatal deaths occurred (18.3%); mortality was 42.9% in the high-severity group and 5.3% in the low-severity group. The prenatal renal finding was confirmed postnatally in 22 cases, while renal-specific follow-up was unavailable in 18. Conclusions: Termination recommendations issued after prenatal detection of a renal anomaly were shaped by the timing of diagnosis, expected renal prognosis, the wider fetal phenotype, and the availability of genetic information. The observed difference between the council recommendation and the parental decision, together with substantial variation in postnatal outcomes, supports individualized counseling within a multidisciplinary framework.