The renal system is the main regulator of fluid volume, electrolyte concentration and pH level in the body, and the kidneys begin to grow during the first month of the fetus’s life, and you may experience many problems during fetal development, these problems can lead to complications after birth, but the correct diagnosis Early treatment can reduce the risk of these complications.
What are the most important congenital renal problems in the fetus?
Kidney problems that can occur during a developing fetus include congenital anomalies and kidney dysplasia. Congenital malformations occur more in the kidneys than any other organ in the body, and some of them are non-symptomatic and do not cause any health problems and are only discovered by chance, and some of them lead to serious disorders that may be life-threatening, and the most important malformations:
Congenital absence of the kidney: bilateral non-formation of the kidneys leads to Potter''s syndrome, in which renal dysplasia is associated with structural abnormalities of the face and limbs, and affected children are born dead (stillborn) or die within a short period after birth.
Single kidney: In this case, there is a lack of development of one of the two kidneys, and one child out of every 500 is born and has a single kidney, and this condition is revealed by chance, and although it usually corresponds to normal life, it is often associated with other abnormalities, and the possibility of infection increases With sepsis and stones in a single kidney, it must be monitored periodically.
Multiple kidneys: There may be a third kidney in very rare cases, and the extra kidney is often atrophic and nonfunctional, and it does not need any treatment unless it causes pathological disorders.
Hypoplasia of the kidney: in this case, the kidney is small in size and lacking in function, and it is usually not symptomatic so it does not need any intervention, but if it causes recurrent infections or high blood pressure, which is not subject to drug treatment, its removal becomes indicated on the condition that the second kidney is normal, and it occurs. This is the case when a pregnant woman abuses alcohol or cocaine.
The sole of the mare kidney: In this case, there is fusion between the lower poles of the two kidneys, and one child out of every 1000 is born and has a kidney sole of the mare, and in most cases the condition is not symptomatic, but it may cause ureteral obstruction at times, and the possibility of infection and stones increases Nephrotoxicity.
The migratory kidney that is out of its normal location: the migratory kidney is usually below its normal position, and most of it is concentrated in the pelvis, due to the lack of ascension in fetal life, and the two migratory kidneys are close to each other and may be attached to the shape of a cake, and in rare cases they may be present in one direction.
Abnormal rotation of the kidney: in fetal life, the kidneys ascend from the lower abdomen towards the top with its rotation to become its navel inward, the failure of the kidney may occur so that its rotation remains towards the front, and a poor rotation may occur and it rotates towards the outside instead of its rotation towards the inside and the navel of the kidney becomes towards the outside And, perhaps, an excessive rotation of the kidney occurs so that its navel is facing backward, and poor kidney rotation is usually associated with the migrating kidney.
Blockage or narrowing of the ureteral pelvic junction: It is the most common cause of renal edema in children, as this blockage or narrowing leads to high pressure within the renal pelvis, an expansion of the pelvis and cysts, and causes gradual destruction of the renal tissue, and the case is bilateral in 20% of cases, and it may reveal In the fetus during pregnancy monitoring, or in the infant during the investigation you reveal the cause of a palpable abdominal mass.
Complete or partial ureteral doubling: In this case, the pelvis and the abdominal part of the ureter are doubled, so that two ureters come out from one kidney, and each ureter of them can pour separately into the bladder, or they meet to form a single ureter and then pour into the bladder, and this case is seen at 1% of Newborns, which are a healthy deformity that causes no symptoms and requires no treatment.
Kidney spongy pulp: characterized by the presence of expansion of the renal tubes, and is associated with a rate of infection and kidney stones more than normal.
Renal cyst and polycystic kidney disease: The polycystic kidney is the most common dysplasia of the kidney, and one of the two most common causes of renal masses in the fetus (besides renal edema), and the kidney in this case consists of many cysts that are not connected to each other and filled with fluid, and the two kidneys are cystic Renal is nonfunctional, but this condition is actually unilateral, and most cases resolve spontaneously.
As for polycystic kidney disease, it is a hereditary disease with a recessive infantile pattern and a predominant cavernous pattern, in the infantile type the condition is discovered during the evaluation of a palpable renal mass in the abdomen in the infant, and the affected infants die within weeks of birth, while the anatomy form is revealed in the adult stage where the cysts are Is very large and eventually progresses to renal insufficiency and a kidney transplant is a good treatment option.
Renal edema: it means the enlargement of the kidney as a result of the blockage that causes the return of urine to it, which leads to its expansion and appearance in a larger size than normal, and it is the most common cause of renal masses in the fetus, and the narrowing or blockage of the ureteral pelvic junction and renal cyst are the most common causes of renal edema. To five degrees, the zero degree indicates the absence of any ascites, while the fourth degree indicates the severe case, and in the event that the fetus is detected with kidney edema, the mother should see a pediatric urologist between the periods 20-30 weeks of pregnancy to monitor the condition of the fetus, It is possible that the condition disappears before birth or in the first few months after birth, so many first, second or third-degree cases do not require treatment, but in the fourth degree, surgery may be performed to correct the defect, which is often sufficient to solve the problem.
How to diagnose kidney problems in the fetus?
Most renal disorders in a fetus are diagnosed before birth by chance by radiography, where a radiologist can visualize the kidneys of the fetus at the 14th or 15th week of development, and at the 20th week the photographer can see the internal structures of the kidneys, and ultrasound helps doctors to Diagnosis of kidney dysplasia and anomalies.
Also, the diagnosis of some cases can be delayed until after birth, where an ultrasound scan or a CT scan is used.
Do congenital renal problems need treatment?
Most renal abnormalities are not symptomatic and are revealed accidentally and do not require any treatment, and in some cases complications may occur that require drug treatment (infection, stones, hypertension, ...), and some special cases require surgical treatment (severe renal edema, hypoplasia, etc.) Blockage or narrowing of the ureteral pelvic junction, polycystic nephritis).
