Renal Pelviectasis - Causes, Symptoms, and Management

Introduction:

When urine gets collected in the baby’s kidneys inside the uterus, the resulting condition is called renal pelviectasis. A ureter is a tube that helps to carry the urine produced in the kidney to the urinary bladder. The renal pelvis is the upper part of the ureter that collects the urine formed and sends it to the lower part of the ureter and then to the urinary bladder. An enlargement in the renal pelvis of about four to ten millimeters is called renal pelviectasis. When it is more than ten millimeters, the condition is severe and is called hydronephrosis. The severity of the condition depends on the underlying conditions and requires immediate attention.

What Is Renal Pelviectasis?

An increased build-up of urine in the fetus’ kidney is termed renal pelviectasis. This can be due to a blockage in the ureter or the bladder that prevents the urine from being passed out. Another reason for this can be the reflux of urine from the bladder to the kidneys. The condition is termed urinary reflux. Renal pelviectasis is a relatively common condition- studies show one in 40 pregnancies has the condition.

What Are the Synonyms of Renal Pelviectasis?

Synonyms of renal pelviectasis can include;

• Pyelectasis.

• Pelviectasis.

• Pelvocaliectasis.

• Caliectasis.

How Is Renal Pelviectasis Different From Hydronephrosis?

There is a collection of urine in the kidneys in both conditions. However, renal pelviectasis usually resolves on its own. However, in very rare cases, renal pelviectasis can become severe and lead to hydronephrosis. The urine build-up is usually minimal in renal pelviectasis; hence, the kidney's enlargement will also be minimal. On the other hand, the blockage in hydronephrosis is severe. More severe cases can cause ballooning of the kidneys.

What Are the Causes of Renal Pelviectasis?

The exact cause of the condition is not yet fully known. The two main causes considered to cause renal pelviectasis are;

• Ureteropelvic Junction Obstruction: When there is an obstruction in the upper end of the ureter, the condition is called ureteropelvic obstruction. As a result of the obstruction, urine gets collected in the kidney. This can cause an increase in the pressure inside the kidney, causing pelviectasis. It can gradually cause a reduction in the function of the kidney.

• Vesicoureteral Reflux: The urine usually passes through the ureter and reaches the urinary bladder. It is stored in the ureter till it leaves the body of the fetus. It then becomes a part of the amniotic fluid. In some rare cases, the urine flows back to the kidneys. This is called vesicoureteral reflux. When the urine stays in the kidney, it can cause an increase in pressure leading to renal pelviectasis.

What Are the Symptoms of Renal Pelviectasis?

Not many symptoms can be noticed in this condition, as it occurs in pregnancy. However mild swelling or enlargement of the kidneys can be observed. It is usually observed through routine check-ups during pregnancy usually around the 20th week.

How Is Renal Pelviectasis Diagnosed?

Renal pelviectasis is usually diagnosed as a part of the routine ultrasound scans during pregnancy. An anatomy scan done around the 20th week of pregnancy helps to find the condition. When the fetus is found to have pelviectasis during pregnancy, constant monitoring would be required.

What Is the Treatment for Renal Pelviectasis?

The condition usually resolves on its own without any treatment. However, constant monitoring of the condition would be required. The baby can be examined by a urologist or a nephrologist after birth. At times a procedure called pyeloplasty would be done. This is usually done to remove the obstruction that can be a cause of the condition. In very rare cases, when the fluid build-up is very severe, and the hydronephrosis can cause damage to the kidneys, the healthcare provider may advise fetal surgery.

Is There a Way to Prevent Renal Pelviectasis?

Renal pelviectasis is a condition that happens as a part of the fetal condition. Hence there is no particular way to prevent it. However, regular monitoring would be required if the condition is found in the fetal stage. If the baby is born with the condition, surgery would be required after evaluating the cause of the condition.

What Are the Complications for Renal Pelviectasis?

After the condition is diagnosed, frequent monitoring would be required. The baby should be watched for any increase in the swelling of the kidney, the amount of amniotic fluid, and the development of the lungs. The urine excreted becomes a part of the amniotic fluid. Hence in this condition, since urine is not excreted, the baby must be watched for the amount of amniotic fluid. The baby usually breathes through the amniotic fluid, which helps the lungs to develop and become strong. However, if the fluid is less, it can indirectly affect the development of the lungs as well.

They can show a tendency to develop kidney diseases as well. Studies show a weak association between renal pelviectasis and chromosomal abnormalities, particularly Down’s Syndrome. However, the severity of the condition has been found to have no association with increasing the risk of chromosomal abnormalities. The American College of Obstetricians and Gynecologists advises genetic counseling and maternal-fetal medicine consultations if more than one marker for chromosomal abnormalities is detected.

How Serious Is Pelviectasis?

Pelviectasis will not generally have a major detrimental effect on the unborn baby. Most infants with pyelectasis are healthy at birth and grow up to be healthy adults. Pelviectasis can occasionally progress into serious hydronephrosis (a disorder that, typically as a result of a blockage or obstruction, results in kidney enlargement and urine retention).

Does Pelviectasis Indicate Down Syndrome?

The presence of pelviectasis on imaging tests indicates the possibility of Down syndrome in the fetus. However, most fetuses with pelviectasis do not develop Down syndrome. The occurrence of pelviectasis is considered normal as long as it is not linked with any other unusual blood tests and imaging findings.

Conclusion

The kidneys are the organs where the wastes are filtered. When urine gets collected in the baby’s kidneys, the resulting condition is called renal pelviectasis. Studies show that one in 40 pregnancies show the condition. It is usually seen in one kidney but can be seen in both kidneys in some cases. Any pregnancy can show renal pelviectasis but it is more common when it is a boy. The exact cause behind the condition is not yet fully known, though an obstruction in the ureteropelvic junction and reflux from the vesicoureteral area are thought to cause it. The condition usually resolves on its own. Studies show that such babies usually have no problems in urinary or renal functions in the future. Constant monitoring is required in babies with this condition.