expectant parents come to see
Congenital kidney and urinary system development abnormalities are common congenital birth defects in children, accounting for 15-20% of newborn birth defects, about 30% need dialysis treatment or kidney transplantation during follow-up.
Congenital kidney and urinary system development malformations include many types, the most common of which is congenital hydronephrosis.
In the past, most children with congenital hydronephrosis were discovered only after they developed low back pain, waist mass, hematuria, urinary tract infection, and even kidney failure.
With the advancement of ultrasound technology and people's emphasis on prenatal and postnatal care, more and more congenital hydronephrosis has been discovered shortly after birth or even during pregnancy.
new problems have followed
mothers-to-be are very confused and worried about the "renal pelvic separation", "renal pelvic dilation", and "mild hydronephrosis" that often appear in ultrasound report sheets. Is this situation serious?
fetal kidney can be displayed under B ultrasound as early as 12 weeks of gestation, and the structure of the kidney can be clearly displayed at 19-20 weeks of gestation.
The renal pelvic cavity of most fetuses is a cord-like anechoic zone. When the anterior and posterior diameter of the renal pelvis is widened beyond the normal range, it is called renal pelvis separation or renal pelvic dilatation. The renal pelvis separation or renal pelvic dilatation reaches a certain degree, which is called hydronephrosis.
Physiological
The kidney and bladder during the fetal period have the functions of forming urine and storing urine, respectively. The hydronephrosis of most babies is a normal physiological phenomenon, especially when the bladder is full. With dynamic observation, most of them gradually decrease or disappear in the third trimester or shortly after birth.
Pathological
A small number of fetal hydronephrosis is pathological, often due to some pathological factors such as congenital ureteropelvic junction stenosis, vesicoureteral reflux, giant ureteral malformations, duplication of kidney, posterior urethral valve, etc., leading to the urinary tract Obstruction, the renal pelvis is significantly expanded, the renal parenchyma is compressed and thinned, and it may affect the neonatal urinary and endocrine regulation functions after birth, and may even develop into chronic renal failure and end-stage renal disease in children. How is
diagnosed?
The standard of ultrasound diagnosis of fetal hydronephrosis varies according to domestic and foreign reports, but most of them believe that the measurement of the anterior and posterior diameter of the renal pelvis (APD) on the cross section of the kidney should be judged and the diagnosis can be made only after the pregnancy. The common diagnostic criteria for fetal hydronephrosis in China are:
below 33 weeks of gestation, APD>4mm
above 33 weeks of gestation, APD>7mm
where 7-10mm is mild hydronephrosis and 10-14mm is moderate hydronephrosis , >15mm is severe hydronephrosis.
However, only one observation can not distinguish whether it is physiological hydronephrosis or pathological hydronephrosis caused by urinary system malformations. Dynamic observation and comprehensive analysis are needed to make a correct judgment.
Physiological hydronephrosis generally does not require further intervention. However, pathological hydronephrosis caused by organic diseases such as urinary system malformations and obstruction requires surgery to remove the obstruction as soon as possible to maximize the prognosis. Of course, these operations are generally performed after the baby is born.
Summary
When ultrasound during pregnancy finds fetal renal pelvis separation, renal pelvis dilation, or hydronephrosis, most of them are physiological, and there is no need to overstress, but it should not be taken lightly. Pregnant mothers must closely observe the baby's changes dynamically, and those who do not subside after birth need to follow up regularly.
If hydronephrosis persists or gradually worsens after birth, and the urinary system malformations, obstruction and other organic diseases cannot be excluded, surgical intervention and treatment should be carried out as soon as possible.
Wen Pediatrics Dr. Li Ningning Chief Physician Ji Lina Edited by
/American Publicity Center Nan Ziyu
Beijing Tsinghua Chang Gung Memorial Hospital is a large-scale comprehensive public hospital jointly managed by Tsinghua University and Beijing.
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