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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?.

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The Management of antenatal pelviectasis – are we there yet?

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  1. The Management of antenatal pelviectasis – are we there yet? Malcolm A. Lewis Consultant Paediatric Nephrologist RMCH

  2. The Management of antenatal pelviectasis – are we there yet? No Thank you, Time for me to leg it!

  3. The Management of antenatal pelviectasis – are we there yet? Lies – damn lies – and statistics(?Disaeli) Clinical trials, follow up studies, RCT’s, registry data

  4. The Management of antenatal pelviectasis – are we there yet? and the result of all this is…. we have become slaves to statistics

  5. The Management of antenatal pelviectasis – are we there yet? but what does this curve really mean?

  6. The Management of antenatal pelviectasis – are we there yet? but what does this curve really mean? SHIT HAPPENS

  7. The Management of antenatal pelviectasis – are we there yet? Patient WH. • Antenatal scans left pelvic dilatation TPD 12 mm • Postnatal scans;- 9 mm

  8. 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

  9. 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

  10. The Management of antenatal pelviectasis – are we there yet?

  11. 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

  12. 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

  13. 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

  14. The Management of antenatal pelviectasis – are we there yet?

  15. The Management of antenatal pelviectasis – are we there yet?

  16. The Management of antenatal pelviectasis – are we there yet?

  17. The Management of antenatal pelviectasis – are we there yet?

  18. The Management of antenatal pelviectasis – are we there yet?

  19. The Management of antenatal pelviectasis – are we there yet?

  20. The Management of antenatal pelviectasis – are we there yet?

  21. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up • What exactly was seen antenatally? 7 mm 8.5 mm

  22. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up • What exactly was seen antenatally?

  23. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up • What exactly was seen antenatally?

  24. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up • What exactly was seen antenatally?

  25. 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?

  26. 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

  27. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up • Bilateral pelviectasis • MCUG • and then…..

  28. The Management of antenatal pelviectasis – are we there yet? So when can we make a diagnosis?

  29. The Management of antenatal pelviectasis – are we there yet? So when can we make a diagnosis?

  30. 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)

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