Transcript The Management of antenatal pelviectasis – are we there yet?

The Management of antenatal
pelviectasis – are we there yet?
Malcolm A. Lewis
Consultant Paediatric Nephrologist
RMCH
The Management of antenatal
pelviectasis – are we there yet?
No
Thank you,
Time for me to leg it!
The Management of antenatal pelviectasis – are we there yet?
Lies – damn lies – and statistics (?Disaeli)
Clinical trials, follow up studies, RCT’s, registry data
The Management of antenatal pelviectasis – are we there yet?
and the result of all this is….
we have become slaves to statistics
The Management of antenatal pelviectasis – are we there yet?
but what does this curve really mean?
The Management of antenatal pelviectasis – are we there yet?
but what does this curve really mean?
SHIT HAPPENS
The Management of antenatal pelviectasis – are we there yet?
Patient WH.
• Antenatal scans left pelvic dilatation TPD 12
mm
• Postnatal scans;-
9 mm
The Management of antenatal pelviectasis – are we there yet?
Patient WH.
• Antenatal scans left pelvic dilatation TPD 12
mm
• Follow up 09/06/2009 – age 13 months;-
5.7 mm
The Management of antenatal pelviectasis – are we there yet?
Patient WH.
• Antenatal scans left pelvic dilatation TPD 12
mm
• Follow up 22/06/2010 – age 24 months;-
37.3 mm
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
• Pathophysiology of antenatal renal tract dilatation
• Conditions associated with renal tract dilatation
• Investigation and follow up
The Management of antenatal pelviectasis – are we there yet?
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
The Management of antenatal pelviectasis – are we there yet?
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
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
The Management of antenatal pelviectasis – are we there yet?
Investigation and follow up
• What exactly was seen antenatally?
7 mm
8.5 mm
The Management of antenatal pelviectasis – are we there yet?
Investigation and follow up
• What exactly was seen antenatally?
The Management of antenatal pelviectasis – are we there yet?
Investigation and follow up
• What exactly was seen antenatally?
The Management of antenatal pelviectasis – are we there yet?
Investigation and follow up
• What exactly was seen antenatally?
The Management of antenatal pelviectasis – are we there yet?
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?
The Management of antenatal pelviectasis – are we there yet?
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
The Management of antenatal pelviectasis – are we there yet?
Investigation and follow up
• Bilateral pelviectasis
– MCUG
– and then…..
The Management of antenatal pelviectasis – are we there yet?
So when can we make a diagnosis?
The Management of antenatal pelviectasis – are we there yet?
So when can we make a diagnosis?
The Management of antenatal pelviectasis – are we there yet?
So what can we say about antenatal pelviectasis
Start worrying……………
details to follow
The Jewish mother’s telegram (? Text now)