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Currently
most pregnant women undergo one or two ultrasound
scans during their pregnancy. When the fetus is
scanned, kidneys and the urinary tracts are analyzed,
In addition the volume of liquor (amniotic fluid) also
helps to suspect kidney problems. Of late stretching
of the kidney (Hydronephrosis) is detected very
frequently.
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| Kidney
Stretching (Hydronephrosis) |
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During
scanning of 100-200 pregnant ladies, one fetus is
found to have this abnormality. This usually happens
because of a blockage in the urinary tract. Before
proceeding further it is essential to describe the
normal arrangement of the kidneys.
In human body there are two kidneys, one on either
side of belly. From each kidney urine drains out via a
tube called ‘ureter’ into a common urinary
bladder. The bladder is located in the lower most part
of belly. Once enough urine accumulates, it empties
via a tube called ‘urethra’. Whenever there is a
block in any of these tubes, kidney stretching
results.
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Single
Kidney Stretching (Unilateral Hydronephrosis)
When only one kidney (right or left) stretches, blockage is
suspected only on that side. When kidneys only stretch, the
blockage is suspected at a higher location (PUJ obstruction).
When the pipe draining the kidney also stretches, blockage is
suspected at a lower location (VUJ obstruction).
Newborns with this problem need to be scanned on the third day
after birth. In general very mild stretching is likely to
settle spontaneously. Huge stretching requires surgery
urgently to prevent loss of kidney function (renal failure).
Children with moderate stretching need close monitoring with
repeat scans and further tests. It is essential to consult a
pediatric urologist to determine what tests are required and
when a surgery could be avoided. Also it is essential to
prevent urinary infection by taking a small dose of antibiotic
once at night.
Both Kidneys Stretching (Bilateral Hydronephrosis)
When both kidneys stretch, they can be blocked separately. But
usually they are blocked as urine exits the bladder in the
‘urethra’. In boys a valve like blockage can result in
stretching of both kidneys (posterior urethral valve – PUV).
Immediate endoscopic intervention after birth is essential to
prevent urine infection and kidney failure.
Consultation before birth (Antenatal Counseling)
When there is a fetal kidney problem, there could be a lot of
anxiety among parents. Consulting a paediatric urologist can
relieve the anxieties and also provide answer to many
questions. It will help to plan the type of delivery, place of
delivery (where the treatment is available to the baby after
birth), the type of tests required after birth. Also it helps
to find out more about what is expected in the long run
(prognosis) and whether the problem can occur again in future
children (familial incidence).
Key Points:
It is possible to determine kidney problems in the baby before
birth.
Most of the kidney problems correct spontaneously, although it
is essential to confirm this by consulting a Paediatric
Urologist
A small proportion of babies require corrective surgery after
birth.
By consulting before delivery, parents can relieve their
anxieties.
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