Antenatal Diagnosis and Management of Renal Problems

R Bhimma
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Antenatal Diagnosis and Management of Renal Problems - Abstract
Advances in imaging techniques have made it possible to diagnose, and in several cases, treat foetal anomalies detected antenatally. Ultrasound (US) is the most commonly used prenatal screening modality that uses high frequency sound waves to detect specific body parts and measure distances. Studies have shown lethal abnormalities are found in about 2% of all foetuses screened, with genitourinary (GU) anomalies being most common. All infants with GU anomalies diagnosed antenatally on US should undergo postnatal US evaluation at birth and at 4-6 weeks of age. Further evaluation can be safely limited if US evaluation at 6 weeks of age is normal. This review will focus on the commonly diagnosed antenatal GU anomalies and management postnatally.

Advances in imaging techniques have made it possible to diagnose, and in several cases, treat foetal anomalies detected antenatally. Ultrasound (US) is the most commonly used prenatal screening modality that uses high frequency sound waves to detect specific body parts and measure distances that has been used since the 1970s [1]. Studies have shown lethal abnormalities are found in about 2% of all foetuses screened, with genitourinary (GU) anomalies being most common [2-4]. The most common GU anomalies detected on antenatal US and the earliest trimester in which it can be detected is shown in Table 1. GU anomalies have an incidence of 1 to 4 in 1000 pregnancies [5], representing 15-20% of all prenatally diagnosed congenital anomalies. On postnatal follow-up about 60% of children having surgery for renal or urinary tract abnormalities in the first five years of life have been diagnosed antenatally [6].
All infants with GU anomalies diagnosed antenatally on US should undergo postnatal US evaluation at birth and at 4-6 weeks of age. Further evaluation can be safely limited if US evaluation at 6 weeks of age is normal [7]. This review will focus on the commonly diagnosed antenatal GU anomalies and management postnatally.

Table 1: Earliest trimester in which the anomaly is detected.
Trimester of Prenatal Anomaly Identification
  1stTrimester(1-12 weeks) 2ndTrimester(13-27weeks) 3rdTrimester(28-40weeks)
Renal   Bilateral renal agenesis
Unilateral renal agenesis
Autosomal recessive polycystic kidney disease
Autosomal dominant polycystic kidney disease
Duplex Kidneys
Horseshoe Kidney
Cross fused renal ectopia
Fused Pelvic Kidney
Hydronephrosis
Multicystic dysplastic Kidney
Renal hypoplasia
Pyelectasis / renal pelvic dilation
Mesoblastic Nephroma
 
Ureteral Anomalies   Ureterocele Ureter duplication
Ectopic ureter
Megaureter
Ureteropelvic junction obstruction
Vesicoureteral Reflux     Vesicoureteral reflux
Bladder Anomalies MMIHS
Patent Urachus
Menkes disease
Exstrophy Bladder diverticulum
Adapted with permission [1]



References
Antenatal Diagnosis and Management of Renal Problems Antenatal Diagnosis and Management of Renal Problems 04/04/2016
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