Early Pregnancy Renal Anhydramnios (EPRA) is a condition where a pregnant woman does not have amniotic fluid around her fetus (baby) because of problems with the baby’s renal system. EPRA occurs when the baby’s kidneys, ureters, bladder, or urethra fail to properly develop, interfering with the baby’s ability to make or pass urine. After 16 weeks of pregnancy, the baby’s urine contributes more than 90% of the amniotic fluid around the baby. Amniotic fluid is essential for normal lung development in the baby. Untreated EPRA is considered universally fatal.

The Renal Anhydramnios Fetal Therapy (RAFT) study is testing an experimental treatment for mothers and their babies affected by EPRA. The study seeks to determine whether repeated injections of fluid (amnioinfusions) into the uterus can reverse the effects of EPRA such that affected babies have enough lung function to survive outside the womb.

The Renal Anhydramnios Fetal Therapy (RAFT) trial is lead by Dr. Jena Miller, M.D., Assistant Professor of Gynecology and Obstetrics in the Johns Hopkins Center for Fetal Therapy and Dr. Meredith A. Atkinson, M.D., M.H.S., Associate Professor of Pediatrics in Division of Pediatric Nephrology. It is funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supported by the North American Fetal Therapy Network.

ClinicalTrials.gov Identifier: NCT03500328
Project information on NIH RePORT

For more information, please contact one of the participating clinical sites in the map below.

RAFT is funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supported by the North American Fetal Therapy Network (NAFTNet) and NAPRTCS.

Relevant Literature

Jelin AC, Sagaser KG, Forster KR, Ibekwe T, Norton ME, Jelin EB. Etiology and management of early pregnancy renal anhydramnios: Is there a place for serial amnioinfusions? Prenat Diagn. 2020 Apr;40(5):528-537. doi: 10.1002/pd.5658. Epub 2020 Feb 19. PMID: 32003482.

Jelin EB, Atkinson M, Keiser A, Blumenfeld YJ, Baschat AA. Response to “Contemporary Outcomes of Patients with Isolated Bilateral Renal Agenesis with and without Fetal Intervention” by RAFT Investigators. Fetal Diagn Ther. 2020;47(10):785-786. doi: 10.1159/000509749. Epub 2020 Aug 7. PMID: 32772023; PMCID: PMC7556342.

Sugarman J, Anderson J, Baschat AA, Herrera Beutler J, Bienstock JL, Bunchman TE, Desai NM, Gates E, Goldberg A, Grimm PC, Henry LM, Jelin EB, Johnson E, Hertenstein CB, Mastroianni AC, Mercurio MR, Neu A, Nogee LM, Polzin WJ, Ralston SJ, Ramus RM, Singleton MK, Somers MJG, Wang KC, Boss R. Ethical Considerations Concerning Amnioinfusions for Treating Fetal Bilateral Renal Agenesis. Obstet Gynecol. 2018 Jan;131(1):130-134. doi: 10.1097/AOG.0000000000002416. PMID: 29215523.

Huber C, Shazly SA, Blumenfeld YJ, Jelin E, Ruano R. Update on the Prenatal Diagnosis and Outcomes of Fetal Bilateral Renal Agenesis. Obstet Gynecol Surv. 2019 May;74(5):298-302. doi: 10.1097/OGX.0000000000000670. PMID: 31098643.

Thomas AN, McCullough LB, Chervenak FA, Placencia FX. Evidence-based, ethically justified counseling for fetal bilateral renal agenesis. J Perinat Med. 2017 Jul 26;45(5):585-594. doi: 10.1515/jpm-2016-0367. PMID: 28222038; PMCID: PMC5509412.

Bienstock JL, Birsner ML, Coleman F, Hueppchen NA. Successful in utero intervention for bilateral renal agenesis. Obstet Gynecol. 2014 Aug;124(2 Pt 2 Suppl 1):413-5. doi: 10.1097/AOG.0000000000000339. PMID: 25004316.

Sheldon CR, Kim ED, Chandra P, Concepcion W, Gallo A, Su S, Grimm PC, Alexander SR, Wong CJ. Two infants with bilateral renal agenesis who were bridged by chronic peritoneal dialysis to kidney transplantation. Pediatr Transplant. 2019 Sep;23(6):e13532. doi: 10.1111/petr.13532. Epub 2019 Jul 1. PMID: 31259459.