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Friday, August 1, 2014
Urinary and Genital Disorders (Children)
Kidneys Appear Enlarged on Prenatal Ultrasoun
I have had a very difficult pregnacy thus far. On Nov. 2, I had my genetics test results come back positive for high AFP levels. I had an amnio and blood tests because the ultrasound showed massive ascities (which doctors told me was fatal) in the abdominal cavity. The blood tests and amnio all came back normal. I then had a pericentis done on the fluid in the baby, which showed that it caused by a lymphatic leak. As of today, the ascities is gone but the ultrasound this week and last week showed a new problem (seemingly unconnected to the ascities). The kidneys appeared enlarged. I am 23 weeks and the kidneys measured 33. My amnio is low, at 2.6 and the bladder seems small. Again, the doctor told me that my prognosis looks grim- it will most likely result in the death of the baby (because he doesn`t think the kidneys are working and they could block the growth of the lungs). Can you give me any hope? There is no history of kidney problems on either side of our families. I am desperate for some good news. This is our first baby, a little boy.
You have provided a lot of information, but the specific problem with your baby is unclear. I am uncertain what you mean with the term "kidneys measured 33". In some babies there is an obstruction of the lower urinary tract preventing normal passage of urine into the amniotic cavity. That obstruction can cause dilation or enlargement of the kidneys, and reduced amniotic fluid volume.
In occasional cases shunting of the urine in the bladder into the amniotic sac can reestablish the amniotic fluid to a normal volume and allow normal lung development, but unfortunately that often is unsuccessful. The best test to determine whether the shunting procedure will be beneficial is to withdraw a small amount of urine from the bladder every 2 to 3 days and analyze it for sodium, chloride, osmolality, and beta 2 microglobulin. If the levels are low, then draining the bladder may be beneficial. Good luck with your decision.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University