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Baby beans: Caring for your kiddo’s kidneys

By Debra Guinn, MD, maternal-fetal specialist, Montana Perinatal Center, and Vassilis J. Siomos, MD, urology specialist, Urology Associates

Getting an ultrasound when pregnant can serve many purposes. Of course, there is the awe and excitement of seeing your unborn baby for the first time, hearing the tiny heartbeat and learning the gender of your much-anticipated new addition. These are wonderful insights that technology provides, but wasn’t widely used until the early 1990s.

Are ultrasounds essential for every pregnancy?

Besides the joy of getting a first glimpse of your growing baby, ultrasound is a very useful imaging tool that allows your medical provider to screen your baby for any red flags prior to birth. While no parent wants to receive potentially alarming news, ultrasounds can certainly put minds at ease or give extra time to prepare and plan for any complications that may be detected.

One area that requires a keen eye during an ultrasound is the urinary tract of a fetus. This system of organs includes the kidneys, ureters, bladder, urethra and genitalia. Not only are these some of the most complicated organs to form while in the womb, but it is also common to find abnormalities here.

Montana Perinatal Center (MPC) providers work closely with Montana Children’s Specialists, a group of pediatric subspecialists, at Kalispell Regional Healthcare to assist with our smallest patients before they have even arrived. Dr. Vassilis Siomos coordinates care for these babies prior to birth and then with your pediatrician after delivery to ensure that you and your baby receive quality care throughout the process.

How common is it to detect a urologic problem in utero?

A urologic abnormality is detected in about one in a hundred babies using ultrasound imaging during an anatomy scan. This typically happens between weeks 18 and 22 of pregnancy, when the kidneys and bladder can be seen. This scan offers vital information about a baby’s tiny body. Simply put, your provider checks how everything is forming during pregnancy and whether organs are functioning properly.

If any irregularities are noted, ongoing monitoring is essential to track changes. There are rare, but specific, situations where procedures or surgery are performed to protect your baby’s urinary system. Most often, providers prefer to perform surgery when the infant is 4 to 6 months old. It may be necessary in certain cases to proceed more urgently if recurrent urinary tract infections occur. For example, if there is a blockage in the urinary system concurrent with a urinary tract infection, kids can get quite ill and may need to be hospitalized. High-grade fevers with infections have been shown to cause kidney scarring or possibly long-term damage resulting in high blood pressure later in life. Undoubtedly, ultrasounds are diagnostic tools that can help medical providers be proactive in protecting the kidneys.

How do kidneys develop?

The urinary system of a fetus begins to develop and mature at eight weeks. The kidneys start growing low in the pelvis, close to the bladder, and then after receiving chemical and hormonal signals, these baby beans rise up and rotate to where they are seen at 15 to 20 weeks gestation.

What potential and common concerns are detected with an ultrasound?

Usually there is one ureter tube for each kidney, but sometimes there are two. When two tubes are detected for one kidney, further examination may be necessary to rule out any potential complications. Similarly, if the chemical signals are disrupted during fetal development, sometimes kidney abnormalities include two kidneys on the same side or potentially fused in the middle, commonly called a horseshoe kidney. Another situation where ultrasound imaging can be helpful is a condition called oligohydramnios. This is when the amniotic fluid is lower than normal levels, which could indicate that the kidneys are not functioning as they should be. Rarely, cysts on the kidney may be discovered, or even an absent kidney.

If the kidney is swollen, this is called hydronephrosis. Hydronephrosis is a term which means that there is fluid backing up in the kidney. This is the most common anomaly of the kidneys found on prenatal ultrasound. This can be a result of a narrow ureter, at the top or bottom, which puts pressure back on the kidney or even as far down as the bladder. This is like squeezing a water balloon and seeing the top swell up to accommodate the extra pressure. The majority of hydronephrosis cases resolve on their own, but this depends on how severe it starts out. After a baby is born, if there was prenatal hydronephrosis, an ultrasound is performed within the first few weeks of life to determine the severity.

Sometimes hydronephrosis can be a sign of urinary reflux, meaning that the urine is going backwards into the kidney. Normally, urine flows from the kidneys through the ureters to the bladder. The muscles of the bladder and ureters, along with the pressure of urine in the bladder, prevent urine from flowing backward through the ureters. However, urinary reflux can allow bacteria, which may be present in the urine in the bladder, to reach the kidneys. This can lead to kidney infection, scarring and damage.

Part of the urinary tract includes the genitals. In the case of male newborns, it’s not uncommon for parents to seek medical advice about circumcision. Circumcision has been shown in some studies to decrease the risk of urinary tract infections in neonatal boys. This risk is low anyway, but if a child has a urinary abnormality it should be considered.

What happens if the prenatal ultrasound identifies a urologic issue?

In general, patients return for a reevaluation around the 34-week mark (the seventh or eighth month of pregnancy). Many times the situation improves without intervention; however, if that is not the case, MPC providers then collaborate with Dr. Siomos to develop a plan of care. All providers are on board, including your selected pediatrician, so that care is seamless throughout pregnancy, delivery and postnatal phases.

Quality care is important through all stages of life, but extremely critical during pregnancy. Ultrasound technology is not a necessary step during pregnancy, but it offers many benefits: the thrill of seeing tiny toes and fingers, the peace of mind for mothers and fathers that all is going well, or a little extra knowledge to help prepare providers and parents for any advanced care that may require some prior planning. Call the Montana Perinatal Center to schedule an ultrasound at (406) 257-3872, or find MPC online at krh.org/MontanaPerinatalCenter to learn more about our services.

Vassilis J. Siomos, MD, is a board-certified urologist focused on pediatric and adult urologic care. He sees patients in Whitefish and Kalispell and has recently started traveling to Eureka for appointments.

First published in Montana Woman magazine, October 2017