Today, most congenital diseases can be diagnosed with ultrasound during pregnancy. Approximately 20% of these problems consist of disorders related to the kidneys, urinary tract and bladder.
If a problem is detected in the unborn baby, the possible cause, pre- and postnatal risks and other additional problems should be investigated. Even if the urinary problem in the baby is very serious, most of these mothers do not have a problem during pregnancy, the baby can be born normally and appear healthy after birth. Since most of these babies do not show symptoms, they are sent home without any examination. When the disease shows symptoms, serious damage has often developed in the kidneys. Therefore, diagnosis in the womb is of great importance. Thus, serious risks can be reduced by taking precautions in the early postnatal period.
KIDNEY ANOMALIES
What is multicystic dysplastic kidney disease? The kidney is in the form of a mass (ur) shaped like a bunch of grapes, consisting entirely of cysts and not functioning at all. Since the opposite kidney usually develops normally, it does not pose a life-threatening risk to the child. After birth, most of them shrink and disappear on their own within a few years. This cystic kidney mass, which is very large (7 cm) or does not work in cases that cause complaints, is removed by surgery. What is polycystic kidney disease? There are many small cysts (vesicles) in the kidneys. Most are bilateral, meaning that both kidneys are severely damaged and barely functioning. Amniotic fluid decreases on pregnancy ultrasound. For this reason, abnormalities occur on the baby's face and body. The infantile type is usually fatal. If the diagnosis is made before the 24th week of gestation, the pregnancy can be terminated with the approval of the family and the decision of the ethics committee. Horseshoe kidney: The lower poles of both kidneys are attached to each other in the form of a bridge. The ureters pass over this bridge. 80% have additional anomalies. Non-urological anomalies, UPD and VUR are common. After birth, the risk of partial urine accumulation, hydronephrosis, infection and stones is higher. Most of them may not cause any complaints throughout life. Diagnosis is made with DMSA scintigra. There is a slightly higher risk of tumor development. Therefore, monitoring is required at regular intervals.
What are the risks for the baby? If there is enlargement in only one kidney, the relevant kidney may be affected, but there is no serious risk for the child. ktur. This condition usually does not cause problems with the baby's development in the womb and birth. In addition, it does not affect the care of the baby after birth.
In babies with severe hydronephrosis in the womb, the kidneys may deteriorate and the fluid in which the baby swims may decrease. This is a serious condition and the child's lung and kidney development is impaired. This situation, although rare, can lead to stillbirth or endanger the baby's life immediately after birth. Therefore, careful follow-up is required throughout pregnancy and after birth.
The main goal is to determine the cause and severity of hydronephrosis. Diagnosis and follow-up of hydronephrosis vary depending on the cause.
The severity of hydronephrosis and its cause in most cases are determined by ultrasound.
Hydronephrosis is the most common fetal pathology diagnosed in the prenatal period. Its frequency in all pregnancies is 1-2%. Neonatal hydronephrosis is completely different from adult. What is Hydronephrosis (Kidney Enlargement)? It is the expansion of the kidney chamber, called the renal pelvis, by filling it with urine. It is the most common urinary problem detected by ultrasound during pregnancy. It may be accompanied by chromosomal anomalies. Önen hydronephrosis staging can be used to determine the severity of renal enlargement.
When is it detected in the womb? How does he watch? Most hydronephrosis occurs after the 16th week of pregnancy. Most of them are mild and resolve spontaneously. However, the earlier it occurs in pregnancy and the more severe it is, the greater the risk of kidney damage and surgery after birth.
What is the urinary system? What's the use? Urinary system; It consists of the kidneys and the collecting system. The parts that make up the collecting system are the renal pelvis (kidney chamber), ureters (urinary ducts), bladder (urinary bladder), sycter (valve, valve) and urethra (urinary tube).
The kidneys produce urine in our body. It filters and cleans excess water and waste materials. The collecting system ensures the transportation, storage and discharge of urine produced in the kidneys.
CAUSES OF HYDRONEPHROSIS
What is ureteropelvic junction stenosis (UPD) (stenosis in the kidney outlet)? It is a stenosis at the junction of the renal pelvis and the urinary tract. In this case, urine from the kidney cannot pass into the bladder easily and accumulates in the kidney. It should be monitored with ultrasound during pregnancy and after birth. However, kidney gene If kidney function increases significantly or kidney function is impaired, it is corrected by surgery in the postpartum period.
What is ureterovesical junction stenosis (UVD)? It is the inability to pass urine easily as a result of stenosis at the entrance (junction) of the ureter to the bladder. Accordingly, the ureter and kidney expand. It needs to be monitored with ultrasound throughout pregnancy and after birth. Mild cases resolve spontaneously, but if kidney and ureter enlargement increases significantly or kidney damage occurs, it is corrected with surgery in the postpartum period.
What is vesicoureteral reflux (VUR) (urine leakage from the bladder to the kidneys)? Normally, the urinary ducts enter the bladder through a tunnel through the muscle layer. This structure acts as a valve (valve). Thus, urine coming to the bladder is prevented from flowing back towards the ureter and kidney. The backflow of urine from the bladder to the kidneys due to a defect in this structure is called vesicoureteral. This can cause kidney infection and kidney damage. Children who have a urinary infection after birth, have difficulty urinating, or have a wide urinary tract should be examined.
What is the posterior urethral valve (PUV) (curtain in the urinary tube)? There is a curtain (valve) at the exit of the bladder, located in the first part of the urinary tube, which makes it difficult for the bladder to empty. It is seen in male babies. Diagnosis is made by ultrasound performed in the womb. The bladder wall thickens. Urine accumulates in the bladder. Intrabladder pressure increases. Urine leakage occurs from the bladder to the kidney. It causes enlargement of the urinary tract and kidneys. It is a serious condition that can completely disrupt kidney function because both kidneys are affected. Some very serious babies may require intervention while in the womb. After birth, the diagnosis should be confirmed immediately and urgent precautions should be taken. This curtain must be cut and bladder emptying must be achieved with the cystoscopic (closed) method. Most of these require lifelong follow-up and treatment.
Ureterocele and Ureter duplication (double ureter system) Ureterocele is a condition in which urine cannot pass into the bladder as a result of the end (mouth) of the ureter in the bladder being closed, thus taking up space in the bladder. It is a cystic expansion in the form of a bubble (swelling). Urine from each kidney normally reaches the bladder through a single channel (ureter). In babies with a double ureter system (duplication), the same kidney 2 ureters emerge. Having double urinary tracts does not always cause problems. However, in those with ureterocele, both the kidney and ureter are seriously enlarged and the kidneys are damaged by infection. For this reason, most kidneys with ureterocele require closed surgery shortly after birth.
TIME OF BIRTH AND TYPE OF BIRTH
Regardless of the severity of hydronephrosis, it is accompanied by premature birth. Due to the risk of serious lung development deficiency, delivering the baby at normal time should be a standard approach. In very rare cases, premature birth may be necessary. Unless there is another reason for the mother and the baby, the method of delivery in urinary anomalies is the normal vaginal route.
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