The Management of antenatal pelviectasis – are we there yet? Malcolm A. Lewis Consultant...

The Management of antenatal pelviectasis – are we there yet?

Malcolm A. Lewis

Consultant Paediatric Nephrologist

RMCH


No

Thank you, Time for me to leg it!


Lies – damn lies – and statistics (?Disaeli)

Clinical trials, follow up studies, RCT’s, registry data


and the result of all this is….

we have become slaves to statistics


but what does this curve really mean?


but what does this curve really mean?

SHIT HAPPENS


Patient WH.• Antenatal scans left pelvic dilatation TPD 12

mm• Postnatal scans;-

9 mm



mm• Follow up 09/06/2009 – age 13 months;-

5.7 mm



mm• Follow up 22/06/2010 – age 24 months;-

37.3 mm


• Pathophysiology of antenatal renal tract dilatation

• Conditions associated with renal tract dilatation

• Investigation and follow up


Pathophysiology of antenatal renal tract dilatation

• Fetus is in a state of diuresis

• 7.5 ml/hr at 25 weeks gestation = 10 ml/kg/hr

• 10 ml/hr at 30 weeks gestation = 7.7 ml/kg/hr

• 27 ml/hr at 40 weeks gestation = 7.7 ml/kg/hr

• Postnatal urine production rate up to 2 - 6 ml/kg/hr

• Renal tract elastic so stretching possible


Conditions associated with renal tract dilatation

• Single kidney (agenesis, MCDK)

• Pelviectasis, pelvi-ureteric junction obstruction

• Hydro-ureter, vesico-ureteric junction obstruction

• Vesico-ureteric reflux

• Bladder outlet obstruction, posterior urethral valves

• Duplex systems with ureterocoele


Investigation and follow up • What exactly was seen antenatally?

7 mm 8.5 mm


Investigation and follow up • What exactly was seen antenatally?


Investigation and follow up • Isolated unilateral pelviectasis

– Is the contralateral kidney normal?

– What is the size of the renal pelvis (TPD)?

– Are the calyces dilated?

– Is the kidney big or small?

– Is there a ureter visible?


Investigation and follow up • Isolated unilateral pelviectasis

– Is the contralateral kidney normal?• If yes, chill, if no find the Jewish mother (or nephrologist)

– What is the size of the renal pelvis (TPD)?• <10 mm chill, >15 mm renogram, between follow

– Are the calyces dilated?• May mean obstruction or dysplasia, go to next question!

– Is the kidney big or small?• If big then more likely to be obstructed

– Is there a ureter visible?• If yes could be reflux or VUJO or combination


Investigation and follow up • Bilateral pelviectasis

– MCUG– and then…..


So when can we make a diagnosis?


So what can we say about antenatal pelviectasis

Start worrying……………

details to follow

The Jewish mother’s telegram (? Text now)

The Management of antenatal pelviectasis – are we there yet? Malcolm A. Lewis Consultant...

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