Anyone had kidney problems in fetus found on u/s? - Mothering Forums
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#1 of 16 Old 11-25-2005, 07:30 PM - Thread Starter
 
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My u/s report says the baby has mild pelvicaliectasis in the left kidney. The renal pelvis is dialated to 4mm (the very low end of the range that requires follow up) and mild caliceal dialation, which apparently is more worrisome. Apparently this could by hydrophrenosis.

This problem (if it turns out to be a problem) is almost always fixable with prompt enough treatment and the worst that would happen is surgery on the baby (bad enough) sometime (but not right away) after the birth and it wouldn't affect my birth plans, but I was wondering if anyone else has had a similar diagnosis with follow up and what happened. I would really appreciate hearing your experience.

Thanks in advance.
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#2 of 16 Old 11-25-2005, 10:15 PM
 
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My baby girl has dysplastic/hypoplastic kidneys; the problem was first observed during a prenatal ultrasound.

On the ultrasound, however, they couldn't tell exactly what was wrong-- only that I was measuring a teensy bit small for dates and that one of the kidneys was very difficult to see on the ultrasound while the other was too easily visible (echogenic-- normal kidneys are difficult to distinguish from the surrounding tissue on ultrasound, especially prenatally. BooBah's have always been brighter than normal). The maternal-fetal medicine specialist recommended that we have her kidneys checked after birth, which is what we did.

The first few weeks were the most difficult, with her creatnine, sodium, and calcium levels all very high. Her neonatal ultrasounds (there were two or three) showed us the truth-- she had two kidneys, both were smaller than they should be and the left kidney was much smaller than the right. As of right now (17 months) she is being followed by a pediatric nephrologist periodically and is taking a saltwater solution every day (kids with kidney problems often lose salt which they need to maintain their body weights and healthy bone growth). The first year was harder, she took medication for several UTIs and as a prophylactic measure against UTIs (she had vesico-ureteral reflux, from her bladder to her kidneys) along with the saltwater, but she's totally outgrown that problem.

It's definately easier now than it was in the beginning! She's a beautiful, growing, healthy little girl today.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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#3 of 16 Old 11-25-2005, 11:28 PM - Thread Starter
 
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Thanks Eilonwy for sharing that. What I'm thinking is that all we need to plan to do is ask for a kidney check up directly after birth.

I'm not seeing a doctor during this pregnancy but it's not an OB thing anyway, so I'll probably just wait for the next u/s and consult with a pediatrician later.
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#4 of 16 Old 11-26-2005, 12:31 AM
 
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They found the same thing when I was pg with ds2, who is 15 months now. We did a follow up ultraound at term and the kidney was still a little bigger than the normal range. Ds is a very healthy, vibrant toddler and shows no signs of any kidney problems. Good luck to you mama!
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#5 of 16 Old 11-26-2005, 12:48 AM
 
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my second ds was diagnosed with hydronephrosis prenatally...we brought him in for an ultrasound when he was a couple of weeks old--still showed fluid in the kidneys, so they did more testing (can't remember what it's called--it involved a catheter and an x-ray where they observed the kidneys). in his case, he had kidney reflux on one side and ended up having surgery at 5 months old (they wouldn't have done surgery until later, but he'd already had one UTI despite being on antibiotics, so we opted against waiting). It was definitely scary sending my 5 month old in for surgery, but everything turned out beautifully--they did follow up tests a few weeks later to make sure the reflux was gone, and we haven't had to worry about it since (he's 2 1/2 now...I can barely even find the scar anymore). AND he was on the worst-case scenario end of things as far as hydronephrosis/kidney reflux goes....they grade reflux 1 to 5, with 5 being the worst, and that's what he had. with lower grades, it's much more common for kids to outgrow it without needing surgery. and my understanding is it also very commonly corrects itself before birth. basically, from what you've said, it's too early to worry much right now (easier said than done I know!) and the worst outcome you're looking at really isn't all that bad, in the big scheme of things.
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#6 of 16 Old 11-26-2005, 12:52 AM
 
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It's called a VCUG, which stands for voiding cystourethrogram. BooBah's showed grade IV-V reflux on both sides, which is why she had to take the antibiotics. She had a repeat VCUG at a year which showed that the reflux had corrected itself entirely.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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#7 of 16 Old 11-26-2005, 12:58 AM
 
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Quote:
Originally Posted by eilonwy
It's called a VCUG, which stands for voiding cystourethrogram. BooBah's showed grade IV-V reflux on both sides, which is why she had to take the antibiotics. She had a repeat VCUG at a year which showed that the reflux had corrected itself entirely.
My now 18 yr old daughter had this too, and was on antibiotics until she was 3.

She has a pelvic kidney that was found when she ran a fever at 6 weeks old. They figured out it was because of a UTI. They did an ultrasound and one kidney was in the right place, the other in her pelvis, specifically behind her bladder in front of her uterus. The not so funny thing was.....her grade 3-4 reflux was in the kidney in the right spot!

As it was, she has never had another UTI since the original infection, outgrew the reflux by her 3rd birthday and should be able to have children without difficulty (the pelvic kidney should get out of the way just like other organs do when they make way for the expanding and growing uterus.)
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#8 of 16 Old 11-26-2005, 03:14 AM
 
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I will respond later, tomorrow, but my daughter has hydronephrosis, diagnosed on prenatal ultrasound.

ND

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#9 of 16 Old 11-26-2005, 10:39 AM - Thread Starter
 
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Thanks everyone for your responses. I'm planning a homebirth so there will be no pediatric evaluation immediately post birth, but it sounds like if the problem doesn't totally correct itself before birth, I can go to a pediatrician within the first week and that should be quck enough to get any necessary observations?

Thanks again.
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#10 of 16 Old 11-26-2005, 11:46 AM - Thread Starter
 
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Originally Posted by Naughty Dingo
I will respond later, tomorrow, but my daughter has hydronephrosis, diagnosed on prenatal ultrasound.

ND
Please do share if you have the time, I would appreciate it.
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#11 of 16 Old 11-26-2005, 04:13 PM
 
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Hi! I'm actually really glad to read these stories - I wish I had known about this forum when I was going through this.

DD was diagnosed with hydronephrosis on ultrasound around 20 wks. We did a follow-up at 32 weeks, which showed progression (increased dilation of the upper pole of the right kidney). She had an ultrasound after she was born, and it turned out that she had an extra (third!) ureter, which didn't drain properly. She was on antibiotics for the first 6 months, and then she had surgery to take out the extra ureter and the damaged part of her kidney. That was arguably the most difficult thing I have ever had to do. But it was the right thing to do. She's had nop further problems and is now 18 months old, running around this house trying to drive me mad...

This should not affect your birth plans. I'd recommend taking her in to see the pediatrician within a short time, and certianly make sure he/she knows about it in advance (assuming you already have a ped?) The only thing they might do right away is prescribe antibiotics to prevent a life-threatening kidney infection.

When I was going through this I thought it was the worst thing in the world - I was a wreck. But it's pretty common, and very manageable.

Good luck!
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#12 of 16 Old 11-26-2005, 04:39 PM
 
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Wanted to add, like a pp we were told my dd had fluid on her kidneys. We did quite a few u/s's to follow up and it was there every time.

Well, the u/s on her when she was born showed absolutely NO abnormality. So I think u/s's can be wrong...my ob at the time said there was even a possibility we were seeing something in ME and not in HER.

So there is chance everything could be fine (and I've heard of quite a few other people on various boards/sites have this same thing happen...were told there was a problem when there was none after birth) Good luck!

C ~ mama to (16), (13), (9) (5)

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#13 of 16 Old 11-26-2005, 08:22 PM
 
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Originally Posted by maybebaby
Wanted to add, like a pp we were told my dd had fluid on her kidneys. We did quite a few u/s's to follow up and it was there every time.

Well, the u/s on her when she was born showed absolutely NO abnormality. So I think u/s's can be wrong...my ob at the time said there was even a possibility we were seeing something in ME and not in HER.

So there is chance everything could be fine (and I've heard of quite a few other people on various boards/sites have this same thing happen...were told there was a problem when there was none after birth) Good luck!
Good point. Not only can ultrasound be wrong or confused, but lots and lots of kindey "conditions" found on prenatal u/s resolve themselves before birth. I remember the u/s technician saying that a high percent of hydronephrosis cases resolve spontaneously, and the research I did after that produced the same answers.

Of course, in our case it did not resolve, and my girl is just as healthy as can be - we were glad she never got sick and we were able to resolve her issues surgically. Not my first choice, but the best result I could ask for.
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#14 of 16 Old 11-26-2005, 08:40 PM
 
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ds was born in the hospital and the fact that the hydronephrosis had been diagnosed made absolutely no difference in the care he received there. he was checked out by the kaiser ped doing rounds the day after he was born, who didn't seem much interested in the kidney stuff, in fact. everyone just told us we should schedule tests "in the next couple of weeks." if fluid is still showing up on an ultrasound once the baby's born, you'll probably want to get a referral to a pediatric urologist--IME, regular pediatricians generally don't know a lot about this stuff.
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#15 of 16 Old 11-26-2005, 09:21 PM
 
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the same thing happened to us with ds1 at the 20wk u/s. i had two more u/s to check on it and on the last one (32-34 wks, i can't remember exactly) the problem had disappeared, so luckily that was that for us and we didn't have to bother with anything after he was born.

from what i read about it, it's fairly common in unborn boys and usually disappears on its own. if it's a girl, it's much more likely to be a problem and need special follow-up/treatment.

it might be worth it to ask for a quick follow-up u/s late in your pregnancy so you'll know for sure if you need to do anything about it after baby comes.
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#16 of 16 Old 11-26-2005, 09:38 PM
 
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Hi there.

My daughter has severe hydronoephorsis of the left kidney. It was first diagnosed when I had a routine ultrasound at 8 months gestation. It was not apparent at my level 3 ultrsound at 20 weeks gestation. I had another scan a month after that one at 9 months gestation which showed that the condition had progressed.

We were told that this usually resolves itself by birth, and that this is the most commonly diagnosed prenatal abnormality.

3 days after birth, we had an ultrasound which showed that the condition persisted. We were referred to a pediatric nephrologist. My daughter was placed on prophylactic amoxicillin. Kids with hydronephrosis are prone to upper urinary tract infections due to urinary stasis. Urine flow is a natural barrier to infection. This is compromised in hydronephrosis. Also many kids with this have bladder reflux, which also predisposes to infection. At that time, we still didn't know if our daughter had reflux or not.

At a couple months of age, my daughter had a VCUG which demonstrated there to be no cystoureteral reflux, the most common cause of hydronephrosis. For the VCUG she had to be catheterized. We then went on to have a renal scan with lasix challenge. This test involved a urinary catheter as well as an IV catheter. An isotope was injected into DD's vein and she had to lie on a scanner for approximately an hour. Half way through the procedure, lasix was injected. This test determines if there is a blockage in the ureter, or if it is just kinked. Either thing will cause the decrease in urine flow and hydronephrosis. It turned out my daughter has a kink in her ureter. Good news for us since it is nonsurgical and expected to resolve by age 3.

My daughter developed a UTI after this last procedure. The only time she has been symptomatic for any sort of problem. I realized something was going on because the urine in her diaper was slightly bloody. She had to be catheterized for the urine sample, and when that was positive, she had to have a blood culture to rule out sepsis. The organism we cultured out was somewhat unusual, and it is my belief this infeciton is likely iatrogenic in cause, a result of being catheterized in the hospital.

The prophylactic antibiotics caused my daughter to have bloody diarrhea. I was unable to resolve this using any sort of nutrtional or probiotic support. I finally argued to get her off the antibiotics. She has done well off of them. She had a couple high fevers after that in her first year, and we had to give urine samples to rule out UTI. More invasive catheterization.

My DD is now 20 months old. Her condition is stable, has not gotten worse or better. She is not symptomatic for any sort of problem. We follow her with ultrasounds. Now every 6 months, previously, every 4. It is a wait and see sort of thing. AT 1 year of age, when her condition was not resolving, we repeated the renal scan to see if there was new evidence of physical obstruction of the ureter. Again it was not obstructed, likely to be kinked. Once she turned one, we also didn't have to worry so much about testing for UTI when she had a fever. The reason it is a big deal in younger infants is that a kidney infection can have much more severe consequences than in older children.

I have some concern that my daughter has felt pain as a result of her condition. Everyone has reassured me that no, it is unlikely. But I still worry. My daughter is getting better but has been very sensitive to pain. Almost like she has felt some bad pain before and now is sensitized to it. In her first year, she was extremely anxious and clingy. Not totally a happy kid. That all seems to be getting better.

I have several friends with children affected by hydronephrosis. Most of them have it due to reflux. They have had varying levels of resolution of the condition.

I think in the past this was just as prevalent a problem, but it wasn't diagnosed, due to the fact that people didn't have ultrasounds.

We work closely with a terrific Nurse practitioner who works for the pediatric nephrologist. It is a rare appointment when we get to see him. His practice is a busy place and I would really feel like my daughter is just a case file if we didnt' get the attention of this wonderful, knowlegable, nurse.

Well, this is pretty long. This has been our experience. With time we have gotten a lot less stressed out about it. I think if we had not known about this problem from the US, we would not have any idea she has this. I think the morbidity resulting from this condition has been, for my DD, resulting from the invasive testing she has been subject to in routine evalutaion of the condition, and to rule out kidney infections when she was sick.

Good luck. ND

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