Renal pelvic dilation

Renal pelvic dilation refers to excessive of the fetal intrarenal collecting system. Although a different terminology is used, pelviectasis or pyelectasis most often mild dilation, and hydronephrosis reserved for severe cases that are more likely be clinically significant. Normal measurements anteroposterior renal pelvis diameter <4 mm at 16 27 weeks gestation <7 ≥28 gestation.1Odibo A.O. Marchiano D. Quinones J.N. Riesch Egan J.F. Macones G.A. Mild pyelectasis: evaluating relationship between gestational age anterior-posterior diameter.Prenat Diagn. 2003; 23: 824-827Crossref PubMed Scopus (25) Google Scholar,2Chitty L.S. Altman D.G. Charts size: kidney measurements.Prenat 891-897Crossref (86) Scholar urinary tract benign, occurring in 1% 5% all pregnancies, it also can associated with genetic structural disorders. Outcomes range from normal significant anomalies requiring surgical repair.3Plevani C. Locatelli A. Paterlini G. et al.Fetal hydronephrosis: natural history risk factors postnatal surgery.J Perinat Med. 2014; 42: 385-391Crossref (16) Scholar, 4Ismaili K. Hall M. Donner al.Results systematic screening minor degrees dilatation an unselected population.Am J Obstet Gynecol. 188: 242-246Abstract Full Text PDF (159) 5Lee R.S. Cendron Kinnamon D.D. Nguyen H.T. Antenatal as predictor outcome: meta-analysis.Pediatrics. 2006; 118: 586-593Crossref (309) Fetal defined ≥4 ≥7 gestation. The severity categorized on basis age-specific criteria. At gestation, (4 mm), moderate (7 ≤10 (>10 mm). Beyond 28 < 9 (9 ≤15 (>15 mm) (Table).6Nguyen Herndon C.D. Cooper al.The Society Urology consensus statement evaluation management antenatal hydronephrosis.J Pediatr Urol. 2010; 6: 212-231Abstract (384) ScholarTableClassification dilation6Nguyen ScholarClassificationAP 16–27 wk (mm)AP >28 (mm)Mild4 <77 <9Moderate7 ≤109 ≤15Severe>10>15AP, anterior-posterior.Society Maternal-Fetal Medicine. SMFM Anomalies Consult Series #4. Am Gynecol 2021. Open table new tab AP, anterior-posterior. (AP) measured transverse plane, spine ideally positioned 12-o’clock position (Figure 1). Proper caliper placement occurs interior margin parenchyma, measuring across widest portion fluid-containing 2). assessed coronal which aids identification caliectasis 3). Additional ultrasound findings contribute prognosis should reported finding include those indicative congenital anomaly (CAKUT): peripheral calyceal abnormal appearance parenchyma (thickness, echogenicity, presence cysts), dilated ureters, bladder appearance, oligohydramnios.7Nguyen Benson C.B. Bromley B. al.Multidisciplinary classification prenatal (UTD system).J 10: 982-998Abstract (231) These have been described attempts made standardize classifications based these criteria.8Chow J.S. Darge Multidisciplinary system).Pediatr Radiol. 2015; 45: 787-789Crossref (7) ScholarFigure 2Measurement diameterShow full captionCaliper pelvis.Society 2021.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Coronal view kidneysShow captionThe arrows indicate without caliectasis.Society (PPT) Caliper pelvis. caliectasis. incidental common nonspecific abnormalities. Isolated second trimester pregnancy has carry likelihood ratio 1.6 2.78 trisomy 21, although strength this association debated.9Nyberg D.A. Luthy Resta R.G. Nyberg B.C. Williams M.A. Age-adjusted assessment Down’s syndrome during trimester: description method analysis 142 cases.Ultrasound 1998; 12: 8-14Crossref (181) 10Nyberg Souter V.L. Use sonography adjusting Down syndrome.Semin Perinatol. 27: 130-144Crossref (33) 11Orzechowski K.M. Berghella V. syndrome: meta-analysis.Ultrasound 2013; 615-621Crossref (15) 12Agathokleous Chaveeva P. Poon L.C. Kosinski Nicolaides K.H. Meta-analysis second-trimester markers 21.Ultrasound 41: 247-261Crossref (170) Progressive, moderate, commonly vesicoureteral reflux CAKUT, such ureteropelvic junction (UPJ) obstruction, duplicated system outlet obstruction (most due posterior urethral valves).5Lee Scholar,13Braga L.H. McGrath Farrokhyar F. Jegatheeswaran Lorenzo A.J. Associations Initial Grades Urinary Tract Dilatation Risk Groups clinical outcomes patients isolated 2017; 197: 831-837Crossref (21) Fetuses complete significantly impaired function will oligohydramnios anhydramnios. differential diagnosis includes variant physiological transient well pathologic causes, obstructive uropathy. Obstructive causes level ureter, UPJ prolapsed ureterocele system, female fetuses. Obstruction caused by valves, occur males cause keyhole-shaped bladder. Rarer atresia megacystis-microcolon-intestinal hypoperistalsis syndrome, both markedly enlarged dominant finding. If no further abnormalities noted family unremarkable, reasonable perform beyond standard aneuploidy screening. Because counseling context individual’s priori 21 maternal age, previous results, additional findings. there anomalies, consanguinity, suggestive specific condition, diagnostic testing chromosomal microarray (CMA) offered; gene panel exome sequencing sometimes useful if CMA normal, does not detect single-gene pursued, appropriate pretest posttest provider experienced complexities genomic recommended. Given high resolution when pregnancy, single follow-up examination third approximately 32 Normalization AP suggests need routine obstetrical care. suggest warrant closer surveillance examinations 4- 6-week intervals sooner indicated. may benefit consultation pediatric urology nephrology specialist formulate plan evaluation. Timing delivery affected hydronephrosis, preterm demonstrated improve outcomes. alter mode delivery, usual medical indications. For fetuses pathology 11% 15%, increasing 27% 45% 53% 88% respectively.5Lee Scholar,14Dias C.S. Silva J.M. Pereira A.K. al.Diagnostic accuracy detecting surgically managed obstruction.J 190: 661-666Crossref (56) incidence appears constant among any degree uropathy subsequent surgery increases CAKUT.15Perlman S. Roitman L. Lotan al.Severe added value kidneys (CAKUT) prediction outcome.Prenat 2018; 38: 179-183Crossref (3) relatively ultrasound. Enlargement norms indicates thorough genitourinary evidence CAKUT review results related increased 21. Follow-up performed assess persistent progressive dilation. warrants reassured favorable, 85% 90% having In serial assessments warranted, offered. Obstetrical timing