Baby Kidney Problems in Pregnancy: Expert analysis!
There are different types of baby kidney problems in pregnancy such as:
- Fetal Hydronephrosis.
- Kidney Dysplasia.
- Autosomal Recessive Polycystic Kidney Disease.
- Ectopic Kidney.
- Renal Agenesis.
- Unilateral Renal Agenesis.
- Bilateral Renal Agenesis.
In this blog, we’ll discuss the different baby kidney problems in pregnancy, their causes and treatments in detail.
Pregnancy is an exhilarating experience in the life of every woman. Right from the beginning, pregnant women start focusing on everything needed for the proper growth of the fetus. They keep checking on the foods that are harmful or beneficial for the growth of the unborn baby.
What are kidney issues in unborn baby?
Kidneys are one of the most important organs of the human body. A working kidney performs following important functions:
- Kidneys filter toxic materials from the body by producing urine and protect against urinary tract infections..
- Kidneys regulate levels of electrolytes in body.
- A functioning kidney maintains minerals in the body.
- They control blood pressure levels too.
In the case of unborn babies, the kidneys start to develop during the first month of conception. Therefore, baby’s kidneys are among the first organs to be developed. However, there are always chances that a kidney disease can occur in the baby’s kidneys. Genes are responsible in most cases for anomalies in baby’s kidneys. The good news is that early detection (through ultrasound and renal scan) helps in timely treatment of such kidney problems and kidney failure.
1. Fetal Hydronephrosis
Fifth week of gestation is the time when the kidneys of the unborn babies start producing urine. This urine increases the amount of amniotic fluid surrounding the fetus. If there is no kidney damage or kidney infection, the amount of amniotic fluid remains adequate. There are many benefits of an adequate amount of amniotic fluid for the fetuses.
In the condition called hydronephrosis, the urine of the unborn infant keeps on accumulating in the pelvis of the kidneys. As a result, one or both kidneys of the baby start to swell. Mostly, a blockage occurs in the ureter. This does not allow urine to go through its normal passage easily. Severity of hydronephrosis depends on how large the kidney/s have become.
Parents are usually concerned about causes of enlarged kidney in fetus boy or girl.
- A blockage may occur at any point or part of the entire urinary tract.
- Sometimes, the fetus may develop an extra ureter that hinders the movement of urine from the kidneys to the bladder.
- Any other birth defect related to kidney disorder may occur during pregnancy, leading to hydronephrosis as well.
- Sometimes, the urine starts a reflux movement.
- Kidneys may also develop immaturely causing more stress on the pelvis.
Fetal ultrasound is the best approach for babies diagnosed with this condition. Gestation age of 20 to 24 weeks is the ideal time for detecting this disease. An ultrasound can show:
- How each kidney looks like.
- What is the dilatation amount of the kidney’s pelvis.
- Which kidney is affected.
- What is the amount of the amniotic fluid.
- What is the size and thickness of the fetal bladder.
- The accuracy of the emptying functions of the fetal bladder.
If the enlargement of the pelvis goes beyond 10 mm, then there is a diagnosis of severe hydronephrosis. If the enlargement is between 4 and 10 mm, then there is a diagnosis of mild hydronephrosis.
Sometimes the pelvis is enlarged. However, the size is not big enough for diagnosing hydronephrosis. In such cases, doctors diagnose the condition as fetal pyelectasis/renal pelvic dilatation.
For fetal pyelectasis:
- 90% of the cases are solved on their own during pregnancy.
- About 10% of cases move towards hydronephrosis.
For fetal hydronephrosis:
Mothers having unborn babies with hydronephrosis need to consult:
- 15% of mild fetal hydronephrosis cures on its own.
- 85% of mild fetal hydronephrosis leads towards abnormal urinary tract in babies.
- Of these 85% cases, only 10% or 15% babies need surgeries in after birth.
- Gynecologists who are expert in handling high-risk pregnancies.
- A pediatric urologist who specializes in urinary tract diseases.
- Nephrologists who deal with kidney disease.
After the baby is born, he or she will be kept in the nursery for observation. Several ultrasounds are carried out to check the development of kidneys and kidney function. High blood pressure issues are also checked.
2. Kidney Dysplasia
Kidney dysplasia is an abnormality of the internal structures of fetal kidneys. In normal development, thin tubes grow into a network of branches. These tubules are responsible for collecting and passing the urine from the kidneys. Urine flows through specific mechanism. However, these tubules fail to form branches in kidney dysplasia. As a result, flow of urine is stopped.
The urine starts accumulating inside the kidneys. This leads to formation of sacs called cysts inside the kidneys. These cysts start replacing the normal tissues of the kidneys. That is why this disease is also called multicystic dysplastic kidney disease and renal dysplasia as well.
Following are the major causes of kidney dysplasia in most babies during pregnancy:
- Genes that the fetus inherits from the parents at birth. Such genes can be mutated or altered in nature.
- Genetic syndromes at birth.
- Certain medications used during pregnancy.
- Drug abuse such as cocaine during pregnancy.
Fetal sonograms or ultrasounds are the best way to check for this medical condition at birth. This technique uses a harmless way of sound waves to create images of the internal structures of your baby during pregnancy.
- If the two kidneys of the unborn child suffer from kidney dysplasia, such fetuses seldom survive during pregnancy.
- Even if such babies survive, they require;
- Kidney transplant
- If one kidney is affected and other is normal, then they do not require dialysis or kidney transplant for several years in the future. However, still follow up care is necessary as child grows:
- Regular blood pressure checkup.
- Regular urine testing.
- Timely ultrasounds of kidneys and baby’s bladder.
- Regular blood tests.
3. Autosomal Recessive Polycystic Kidney Disease
Fluid-filled cysts are formed in the kidney of fetuses in this rare genetic disorder. Kidneys enlarge in size and blood pressure is affected. ARPKD causes problems in breathing. This occurs because the amount of amniotic fluid decreases. So many babies usually do not survive.
Even if the baby survives during pregnancy, a life-long treatment plan is needed. However since it is an autosomal recessive disease, very few fetuses suffer from it.
ARPKD is an autosomal recessive kidney disease. This means that genes are exclusively involved in this kidney disease. However it is also essential that both the parents pass the mutated gene to the fetus.
If only one parent will provide the gene, then the child will simply become a carrier of ARPKD.
How ARPKD is diagnosed?
Ultrasound imaging or sonogram images give a diagnosis of ARPKD. The disease is diagnosed by doctor and doctor may ask for further information.
- Removing the enlarged kidneys.
- Dialysis and kidney transplants in certain cases.
- Artificial ventilation to treat breathing problems.
- Nutritional guidelines to treat growth failures.
4. Ectopic Kidney
Normally, the human kidneys are located near the middle of the back. An ectopic kidney is present above, below or on the opposite side of the normal position of the kidneys.
The kidneys of fetuses appear in the form of buds at first. These buds appear in the pelvis region. With the passage of time, they travel upwards and occupy normal position. In cases of ectopic kidneys;
- Kidney may move too slow and remain in the pelvis region.
- Both kidneys may occupy the same side of the body.
- Kidney may move very fast and go far above the normal position.
Some possible causes can be;
- A genetic defect.
- Drug abuse.
- A kidney bud that does not develop properly.
- Problems linked with the tissues that direct the movement of kidney buds.
Prenatal ultrasound is the main diagnostic tool for ectopic kidney. Different types of lab tests for the urinary tract also diagnose this condition.
Firstly, an ectopic kidney causes no symptoms. This is the reason that there are no specific treatments. Secondly, It is very rare that both kidneys tend to be ectopic.
5. Renal Agenesis
Renal agenesis is also one of the birth defects. In this condition, the fetus has either only one working kidney or no kidneys at all. There are two types of renal agenesis:
- Unilateral renal agenesis where there is only one kidney.
- Bilateral renal agenesis where both kidneys are absent.
Renal agenesis is a very rare disease that affects kidney function. For instance, unilateral renal agenesis has a 1:2000 ratio. Similarly, bilateral renal agenesis has 1:4500 ratio.
Renal agenesis is generally consider as a genetic disorder. Intrauterine growth restriction, pregnancy complications, alcohol and drugs intake are also causes of this kidney function abnormality.
Prenatal ultrasounds are the basic diagnosis for renal agenesis. Doctors also suggest using genetic testing in such cases.
- There is no cure for bilateral renal agenesis.
- In the case of unilateral renal agenesis, things go fine as long as there is enough amniotic fluid for the fetus. So only one kidney works.
- After birth, doctors suggest regular follow-ups for checking any urinary tract infection.
All in all, baby kidney problems and kidney infections in pregnancy vary among pregnancies. Parents need to choose regular screening to catch any defect right from the beginning. This is the path to success.
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