Renal and Kidney Disease
Normal Fetal Kidneys
One common area of fetal findings is in the fetal kidneys, bladder, or urinary tract. This can range widely in findings and prognosis, and depending on your child’s exact findings may not require delivery at UR Medicine's Golisano Children’s Hospital. Many children can be followed by ultrasound before birth, and then follow up with Pediatric Nephrology (medical renal disease) or Pediatric Urology (problems with flow within the kidneys and bladder tract).
At Golisano Children's Hospital, the Pediatric Nephrology, Pediatric Urology, and Transplant Surgery teams all work together to help children with complex kidney disease. The Pediatric Urology team is the largest and most experienced pediatric urology practice in Upstate New York and the only pediatric urology practice in the in the Finger Lakes region. Every year, these teams care for many infants and children with a variety of kidney and urologic needs.
Over the past 5 years, UR Medicine's Maternal-Fetal Care has cared for and evaluated more than 500 fetuses with a variety of kidney and bladder issues diagnosed in utero.
Some of the more commonly found issues in the kidney and renal system are described below.
Fluid in the Fetal Kidneys
Urinary Tract Dilation (Pyelectasis)
Urinary tract dilation (UTD) is fluid within the collecting system (ureters) that lead from the kidneys to the bladder. This is usually due to a narrowing of the ureter, but can be caused by other factors as well. Mild versions of this are generally a benign finding and it is slightly more common in male fetuses and in children with Down syndrome.
When this is found at another office, you may be referred for evaluation and ultrasound by our team. The fluid levels in the kidneys and ureters will then be followed during pregnancy. Many times these findings will resolve before birth.
Most children with this finding do not necessarily need to deliver at Strong Memorial Hospital for access to Golisano Children's Hospital, but for those with large amounts of fluid or other signs of more severe obstructions, delivery at Strong Memorial Hospital may be recommended. In cases that do not resolve or have higher amounts of fluid, follow-up after birth will be needed with ultrasound, possible administration of antibiotics (to prevent infection), and sometimes surgery.
Chronic Kidney Disease
While an uncommon condition for a child to face, in some cases prenatal ultrasound can suggest that there is a risk for serious renal disease after birth. These infants need close follow-up prenatally, and are often followed by Maternal-Fetal Care for specialized monitoring and ultrasound. Many of these babies will need delivery at Golisano Children's Hospital to allow for evaluation and care after birth by Pediatric Nephrology. This team treats both acute and chronic kidney failure (also referred to as renal failure) through surgery and dialysis, even for the smallest infants.
Bladder Obstruction, Posterior Urethral Valves
Posterior urethral valves (PUV) is an uncommon condition that results in obstruction of the flow of urine out of the bladder into the amniotic sac in utero. When this occurs, the fluid around the baby will decrease or become absent, while the bladder becomes overfull and enlarged. This can lead to a variety of lung development and kidney failure complications.
For fetuses with this rare condition, our Maternal-Fetal Care team may discuss in-utero treatment options including bladder drainage and bladder shunting. We are the only practice in Upstate NY offering these services.
Even with this care, most children with this will need to deliver at Strong Memorial Hospital to allow for evaluation and care after birth by Pediatric Urology and Nephrology as these babies are at high risk for ongoing kidney disease.