Antenatal (Fetal) Hydronephrosis: Incidence, Diagnosis & Causes- Dr A.K.Singal & Dr Ashwitha Shenoy скачать в хорошем качестве

Antenatal (Fetal) Hydronephrosis: Incidence, Diagnosis & Causes- Dr A.K.Singal & Dr Ashwitha Shenoy

Uploaded by Pediatric Urology Department, MITR Hospital, Kharghar, Navi Mumbai, India. Phone: +91-22-27743558/4229/4269 and +919324180553 Antenatal Hydronephrosis 1 Definition, diagnosis 1. What is antenatal hydronephrosis? a. Hydronephrosis is the swelling of the kidney due to buildup of urine in the kidney. When this is detected before birth, it is called antenatal hydronephrosis. It can be unilateral (on one side) or bilateral (on both sides). b. Antenatal hydronephrosis is usually diagnosed on an ultrasound which can be as early as 15 weeks of pregnancy. The advancement in USG has helped in detecting the hydronephrosis early which in turn helps in early treatment and can prevent further renal damage and loss of renal function. 2. What is the incidence of antenatal HDN? a. Hydronephrosis is one of the most common anomalies affecting 1% of all pregnancies. Generally it is one sided, sometime both kidneys may be involved. Male and female children are equally involved. b. All pregnant woman should have an ultrasound done with clear imaging of kidneys. Based on ultrasound we can grade the hydronephrosis which will help in identifying the severe ones and plan an early postnatal management if required. 3. What are the causes for antenatal hydronephrosis? a. Unilateral – most common PUJ, then reflux, then megaureter or ureteroceles b. Bilateral – most common reflux, PUV, Bilateral PUJO 4. When and how can it be diagnosed? a. Earliest diagnosis is possible at 15-18 weeks of pregnancy. Routinely antenatal scan for kidney anomalies are done at 19-20 weeks for kidney anomalies, however some cases are diagnosed later in pregnancy. b. Any fetal HDN, sonologist must measure AP diameter of pelvis, cortex quality, any ureteral dilatation, bladder emptying and liquor volume. This helps in assessing the exact diagnosis as well as severity of hydronephrosis. 5. Whom should you consult if antenatal HDN detected? a. It is important to form a bond with a doctor who is going to treat the child after birth, hence you must meet a Qualified pediatric urologist, nephrologist, or a pediatric surgeon before birth, usually when first time the ultrasound shows hydronephrosis. b. Your pediatric urologist or surgeon will guide you regarding the further follow up during your pregnancy and after birth. So do consult your pediatric urologist at time of first diagnosis and get a plan made and show to your gynecologist. The gynecologist and surgeon can then work together for best outcome for your child. 6. What are the situations where the doctor may advise termination of pregnancy? a. For unilateral hydronephrosis there is no need to worry as one kidney is enough for survival. In most of the bilateral hydronephrosis cases also, the kidney function may be normal and termination may not be needed. b. Only for cases where there is Bilateral hydronephrosis with decreased amniotic fluid before 24 weeks is considered as poor prognosis- doctor may advise a termination of pregnancy and that too after extended set of tests. Endnote: • It may be a very stressful time for the couple when they get to know that their child has a kidney swelling. Hence, meeting an expert who understands the diagnosis and can guide you becomes particularly important. • Do remember that more than 90% of children with antenatal hydronephrosis eventually go on to have a normal life.