Antenatally Detected Renal tract Abnormalities Management, Obstetrics

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Abstract

The aim of this guideline is to standardise referral to appropriate health care providers when antenatally detected renal tract abnormalities are detected

Renal tract abnormalities account for 20% of major fetal anomalies detected in the second and third trimester. The detection rate for these anomalies is in the region of 80%. Although the majority of abnormalities have a favourable outcome or resolve spontaneously, a proportion will go on to have renal dysfunction in the neonatal period requiring medical or surgical intervention. Anomalies may be unilateral or bilateral, associated with renal parenchymal disease and may demonstrate oligohydramnios. Oligohydramnios at early gestations is associated with pulmonary hypoplasia and early neonatal death. Appropriate identification and counselling of these patients should identify those at risk requiring antibiotic prophylaxis and follow up scans and those where outcome is unlikely to be favourable.

During the 18-20 week scan fetal kidneys can be identified as hyperechoic in comparison to bowels. Colour flow Doppler can be used to demonstrate the presence of renal arteries branching from the descending aorta. The ureters are not typically seen and should measure <1mm in diameter. Measurements of the renal pelvis should be taken from the AP diameter. Document any calyceal or ureteric dilatation, uterocole or any parenchymal abnormalities.

This guideline is applicable to all medical, nursing and midwifery staff working with neonates in the West-of-Scotland managed clinical network.

NOTE: this guideline is hosted on the NHSGGC Obstetrics & Gynaecology Handbook website. Clicking on the link below will open the guideline in a new window.

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