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Urinary and Genital Disorders (Children)

Enlarged Kidneys

01/28/2009

Question:

I am 25 weeks pregnant and have had 3 level 2 u/s all indicating enlarged and mildly echogenic kidneys. I have been seen by all high risk maternal fetal medicine OBs. All prenatal testing has been normal including a recent amniocentesis. My next appts are for renal u/s for both my husband and myself, a consult with pediatric urologist and a fetal MRI of the kidneys. I am very concerned about the prospects of autosomal recessive polycystic kidney disease because I am aware of the seriousness of this condition. my appts are not for two more weeks so I have time to freak myself out. This baby was conceived via IVF and I have a very healthy 3 1/2 yo daughter. I have heard that kidney abnormalities are very "normal" abnormal u/s findings and that they are often benign, resolve on their own or require corrective intervention after birth (ie antibiotics, corrective surgery, watchful waiting). my question is how likely is it that this is still the case with my baby? Would they be doing all this additional testing if this was still a possibility? Your advice is much appreciated.

Answer:

I am uncertain by what you mean by enlarged. If they are hydronephrotic (too much urine in the collecting system), then that condition often improves following delivery. This condition may result from urinary reflux, partial or significant ureteral obstruction, or urethral obstruction. If the amniotic fluid volume is normal, it probably is not serious.

If you mean that the kidneys are much longer than normal but are not hydronephrotic, then the answer depends on how long the kidneys are. Children with autosomal recessive PKD have parents with normal kidneys. Usually the kidneys are quite large and very echogenic. In addition, often the amniotic fluid volume is low, because kidney function often is poor.

The pediatric urological visit often provides a significant amount of helpful information. Good luck.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University