Natalie's kidney condition (RPD = Renal Pelvis Dilation) has been upgraded from Fetal Pyelectasis to Severe Fetal Hydronephrosis.
The definition of pyelectasis means that the kidney pelvis (an area that the renal tube connects to) is enlarged/stretched too large (over .4cm). At 32 weeks, natalie's was .8cm , which was enlarged, but they were hoping it would resolve itself.
Anything over .8cm, is no longer Pyelectasis and is then considered Hydronephrosis. Today, it was 1.2cm, so it's categorized as Severe Hydronephrosis. This is considered quite an increase in 4 weeks. (this is my understanding of it, i could be wrong. I will be sure to ask more questions to clarify when the doctor calls me back).
The most common causes of RPD, are obstruction of the ureter where it enters the renal pelvis (an area leading to the inside of the kidney), a kink in the ureter, and another condition where the ureter allows urine to flow backwards from the bladder (can't remember the name of it). There are some less common causes as well, but we didn't go into those.
The chances of a baby with RPD greater than .8cm having to have surgery is high. It could mean that she'll need a stint to reduce the size of the renal pelvis, repair of the renal tube entering the kidney if there is a kink/obstruction in it, or complete replacement of the ureter's location by moving it to another area of the kidney. If left untreated, the urine can back up into the kidney and cause damage to the kidney. Infection is also very likely with this condition, so she'll probably be on antibiotics from birth.
Of course, there's always a chance that the ultrasound after birth will show that it's not as severe as they thought. We're crossing our fingers, yet preparing ourselves at the same time.
My OB is going to call my pediatrician to notify her of the condition and discuss a plan. She's concerned b/c this is something that can cause kidney tissue damage, and the fact that the size is increasing is not good b/c it means that the kidney is not draining and continuing to get worse. She is considering inducing earlier than the 19th, depending on what the pediatrician says. With it being upgraded to severe, they want to get at the baby's body to perform an ultrasound on her b/c it's more accurate to image the baby herself as opposed to through me. If they wait too long, it can cause more complications, leading to permanent kidney damage. This can also help them get a jump on the condition before it becomes more severe and leads to these risks. Another reason they may induce early is so that, if needed, they can do a small procedure right away to drain the kidney (b/c waste and blood can be backing up into the kidney).
On the other hand, they don't want to induce too early b/c they still want to let her finish growing, especially regarding lung development. It's kind of a tough call. It may just be a few days earlier than planned.
On another note, she is no longer breech (yay!) and i will not have to have a c-section unless there are complications for some reason.
I am 2cm dilated and her heartrate was 159bpm today.
Here are images to help describe everything.
DIAGRAM OF NORMAL KIDNEY DEVELOPMENT
DIAGRAM OF ONE KIDNEY WITH HYDRONEPHROSIS (they never said anything about a hydroureter (the ureter looking like that in the picture). It could be that they can't see it on ultrasound yet since it's so tiny, or that portion of the collecting system could be normal and there could be a different cause.)
ULTRASOUND IMAGE OF KIDNEY WITH HYDRONEPHROSIS (This is NOT our u/s. It's just one that looked similar to what we saw. They didn't give me a picture of it, but it looked like this.)
The definition of pyelectasis means that the kidney pelvis (an area that the renal tube connects to) is enlarged/stretched too large (over .4cm). At 32 weeks, natalie's was .8cm , which was enlarged, but they were hoping it would resolve itself.
Anything over .8cm, is no longer Pyelectasis and is then considered Hydronephrosis. Today, it was 1.2cm, so it's categorized as Severe Hydronephrosis. This is considered quite an increase in 4 weeks. (this is my understanding of it, i could be wrong. I will be sure to ask more questions to clarify when the doctor calls me back).
The most common causes of RPD, are obstruction of the ureter where it enters the renal pelvis (an area leading to the inside of the kidney), a kink in the ureter, and another condition where the ureter allows urine to flow backwards from the bladder (can't remember the name of it). There are some less common causes as well, but we didn't go into those.
The chances of a baby with RPD greater than .8cm having to have surgery is high. It could mean that she'll need a stint to reduce the size of the renal pelvis, repair of the renal tube entering the kidney if there is a kink/obstruction in it, or complete replacement of the ureter's location by moving it to another area of the kidney. If left untreated, the urine can back up into the kidney and cause damage to the kidney. Infection is also very likely with this condition, so she'll probably be on antibiotics from birth.
Of course, there's always a chance that the ultrasound after birth will show that it's not as severe as they thought. We're crossing our fingers, yet preparing ourselves at the same time.
My OB is going to call my pediatrician to notify her of the condition and discuss a plan. She's concerned b/c this is something that can cause kidney tissue damage, and the fact that the size is increasing is not good b/c it means that the kidney is not draining and continuing to get worse. She is considering inducing earlier than the 19th, depending on what the pediatrician says. With it being upgraded to severe, they want to get at the baby's body to perform an ultrasound on her b/c it's more accurate to image the baby herself as opposed to through me. If they wait too long, it can cause more complications, leading to permanent kidney damage. This can also help them get a jump on the condition before it becomes more severe and leads to these risks. Another reason they may induce early is so that, if needed, they can do a small procedure right away to drain the kidney (b/c waste and blood can be backing up into the kidney).
On the other hand, they don't want to induce too early b/c they still want to let her finish growing, especially regarding lung development. It's kind of a tough call. It may just be a few days earlier than planned.
On another note, she is no longer breech (yay!) and i will not have to have a c-section unless there are complications for some reason.
I am 2cm dilated and her heartrate was 159bpm today.
Here are images to help describe everything.
DIAGRAM OF NORMAL KIDNEY DEVELOPMENT
DIAGRAM OF ONE KIDNEY WITH HYDRONEPHROSIS (they never said anything about a hydroureter (the ureter looking like that in the picture). It could be that they can't see it on ultrasound yet since it's so tiny, or that portion of the collecting system could be normal and there could be a different cause.)ULTRASOUND IMAGE OF KIDNEY WITH HYDRONEPHROSIS (This is NOT our u/s. It's just one that looked similar to what we saw. They didn't give me a picture of it, but it looked like this.)
ULTRASOUND OF A NORMAL KIDNEY
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