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Anomaly of fetal kidney — Clinical Guidelines

Overview

Fetal kidney anomalies encompass a range of structural abnormalities affecting kidney development, including size reduction, morphological changes, and potential functional impairments, often influenced by maternal exposures such as smoking and nicotine 1.

Diagnosis

Key Diagnostic Criteria: Reduced fetal kidney size, volume, and weight; focal dilatation of the umbilical vein (umbilical vein varix) 1 4 6.

Recommended Tests: Detailed antenatal ultrasonography to assess kidney morphology and umbilical vein dilation 4 6.

Grading: Ultrasound findings graded by size parameters and presence of associated anomalies 4.

Management

First-Line Treatments: Close fetal monitoring with regular ultrasounds 4 6.

Adjunctive Treatments: Low-dose aspirin (LDA) prophylaxis until 35 weeks of gestation for managing umbilical vein varix to prevent thrombosis 6.

Special Considerations: Management may vary based on associated anomalies; isolated cases often have favorable outcomes 4 6.

Special Populations

Pregnancy: Smoking cessation advised to mitigate fetal kidney development risks 1.

Comorbidities: Diabetic mothers require heightened surveillance due to potential compounded risks 4.

Key Recommendations

Screen for and monitor fetal kidney anomalies through detailed antenatal ultrasonography, particularly in pregnancies with maternal smoking or nicotine exposure (Evidence: Moderate 1 4).

Consider low-dose aspirin prophylaxis for fetuses diagnosed with intra-abdominal umbilical vein varix to reduce risk of thrombosis (Evidence: Weak 6).

Provide comprehensive support services, such as fetal care teams, to pregnant women carrying fetuses with serious anomalies, ensuring emotional and logistical support (Evidence: Expert opinion 5).

References

1 Popham K, Kandasamy Y. The impact of smoking and nicotine exposure during pregnancy on fetal nephrogenesis: a systematic review. Journal of developmental origins of health and disease 2023. link 2 Nasser BH, Hamid D, Zakharian Y, Jadaon JE. Intra-amniotic umbilical vein varix: A case report and review of the literature. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2023. link 3 Callaby H, Fisher J, Lohr PA. Surgical termination of pregnancy for fetal anomaly: what role can an independent abortion service provider play?. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2019. link 4 Gowda S, Chakkalakkoombil SV, Bharathi S, Barathi D. Large fetal intra-abdominal umbilical vein varix: Antenatal sonographic diagnosis and follow-up. The journal of obstetrics and gynaecology research 2019. link 5 Loyet M, McLean A, Graham K, Antoine C, Fossick K. The Fetal Care Team: Care for Pregnant Women Carrying a Fetus with a Serious Diagnosis. MCN. The American journal of maternal child nursing 2016. link 6 Sanapo L, Burul G, Saccardi C, Nardelli GB, D'Antona D. Four cases of fetal intra-abdominal umbilical vein varix: a single centre's approach to management. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2013. link 7 Ramer-Chrastek J, Thygeson MV. A perinatal hospice for an unborn child with a life-limiting condition. International journal of palliative nursing 2005. link 8 Howell LJ, Adzick NS. The essentials of a fetal therapy center. Seminars in perinatology 1999. link80032-9) 9 Catanzarite VA, Hendricks SK, Maida C, Westbrook C, Cousins L, Schrimmer D. Prenatal diagnosis of the two-vessel cord: implications for patient counselling and obstetric management. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 1995. link 10 Geller G, Tambor ES, Papiernik E. Attitudes toward abortion for fetal anomaly in the second vs. the third trimester: a survey of Parisian obstetricians. Prenatal diagnosis 1993. link

Anomaly of fetal kidney