Pre-natal Nephrology Evaluations
The Children’s Kidney Center offers comprehensive pre-natal nephrology
consultations for women diagnosed with abnormal fetal renal sonograms.
The consultation involves discussion about the diagnosis, outcome and
management options. These consults include pre-natal evaluation of maternal
disorders that may affect the fetus or of babies with a significant renal
anomaly or urinary tract problem noticed intra-utero.
Renal fetal anomalies can be associated with genetic disorders, isolated
malformations or part of a complex syndrome. Early consultation allows
the parents to understand the differential diagnosis and potential outcome
of the fetus. Detailed explanation is provided regarding post-natal evaluation,
surgical procedures that may be required, nutritional requirements and
“renal protection” measurements that would impact in the renal
outcome and optimize the growth and quality of the child’s life.
The Children’s Kidney Center uses a multi-disciplinary approach,
integrating various medical specialist groups such as Maternal-Fetal Medicine,
Pediatric Urology, Neonatology and Social Work Services.
Antenatal ultrasound has revolutionized the diagnosis and management of
conditions such as hydronephrosis, and appropriate therapy may prevent
the ensuing complications of pyelonephritis and obstruction. A diagnosis
of pre-natal hydronephrosis may be made in up to 1% of newborns and in
20% of these, the condition is significant. Most often, the cause is transient
in-utero obstruction. An anterior-posterior diameter of the fetal renal
pelvis >2 cm by ultrasound is predictive of significant urologic pathology
and such patients may require surgical intervention and/or long-term urologic
care. Of note, most infants are asymptomatic at birth. Post-natal imaging
should be considered in those infants with bilateral hydronephrosis, posterior
urethral valves, and complicated duplex or double drainage systems that
can lead to infection and possibly obstruction.