Prenatal Ultrasound is Key to Detecting Urinary and Kidney Problems
Early Detection is Key
As with most jobs, Dr. Stan Galansky’s chosen profession comes with a difficult part. Almost daily, he needs to tell expecting parents there’s something wrong with their unborn child’s kidneys. But, as with most jobs, his work also involves many rewarding moments: when he lifts the worry from those frightened parents, assuring them that their baby will be okay. Thanks to technology—most notably, the ultrasound—those positive moments are nudging out the negative.
Catching it Early
“Early diagnosis is so crucial,” says Galansky, a pediatric urologist with Rocky Mountain Hospital for Children at Sky Ridge Medical Center. He says that routine prenatal ultrasounds have had a profound influence on his profession. “Many kidney problems that are obstructive have no symptoms and are diagnosed only through ultrasound. Before ultrasound, we would see many kids present in infancy or early childhood with terrible infections, kidney injury or failure.”
Today, Galansky and his colleagues are identifying these common congenital defects of the urinary tract before birth and with growing precision. This allows them to monitor and treat children early enough to ward off life-threatening kidney damage.
Hydronephrosis, the most common condition falling under this category, is a term doctors use to describe stretching (dilation) of the kidneys, ureter or bladder. But simply seeing the term on a baby’s ultrasound report is not cause for alarm.
“Most often, it doesn’t indicate a serious problem,” says Galansky. Many times, the defects are insignificant and correct themselves, he says. “Other times,” Galansky adds, “the stretching results from normal physiological changes that take place in the womb.”
Kidneys in the Womb
In the fetus, the kidneys begin producing urine at 16 weeks. Between 16 weeks and delivery, these little bean-shaped organs are responsible for making the protective amniotic fluid baby floats in, pumping out 30 to 50 times the amount of fluid they will ever make in their lifetime. Also, a pumping action moves the fluid through this high-yielding system, which can cause dilation. If that’s not enough, couple those facts with the large amounts of progesterone being secreted to relax Mom and baby’s muscles and a little elasticity makes sense.
The doctors’ challenge is to detect which dilation signals problems and which problems require early intervention to prevent kidney injury—all while avoiding unnecessary parental anxiety. Although this is not an easy challenge, refined medical and diagnostic tools aid doctors in their task.
Sometimes, doctors find a kink or other obstruction high up in the ureter, the tube that carries urine from the kidneys to the bladder. Less frequently, they find that the other end of the ureter formed too narrowly, obstructing urine flow and building pressure in the kidneys. If the blockage is significant, it can be repaired after birth. Rarely, early induction can be necessary.
More commonly, over-dilation results from vesicoureteral reflux (VUR), an often hereditary condition caused by an ineffective one-way valve. When formed normally, this valve allows only forward flow of urine from the ureter to the bladder. With VUR, when the bladder squeezes to empty, some urine is forced back up the ureter toward the kidneys, which can cause injury or infection. Most VUR cases correct themselves. Sometimes, monitoring with antibiotics to control infection is necessary and more serious cases can require surgical correction. Infection is not an issue in utero, where urine is sterile; but by detecting VUR prenatally, an infant can be treated shortly after birth. Untreated VUR can lead to high blood pressure issues. For instance, in rare cases, a daughter might grow up to be a high-risk pregnancy or incapable of carrying a baby at all.
Early Detection and Treatment
By treating these infants before their urinary tracts are fully mature (at age two), doctors can prevent permanent damage and thus avoid these life-long health issues. “I can fix the plumbing part, where the urine is transmitted. But I can’t fix the kidney, where the urine is made, once the kidney is injured,” Galansky says. “Early detection is safe, painless and relatively inexpensive—and can have a tremendous impact on kids’ lives.”