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Radiology
Bilateral Renal Agenesis
Built from Obstetric Imaging
What’s inside
8 sections · 72 slides
Overview
- The whole story in one slide
- What this session covers
What the condition is
Absent kidneys, and the chain of damage that follows
- Definition
- Why a fetus needs its kidneys
- How absent kidneys become a lethal problem
- Pulmonary hypoplasia, in plain words
- The squashing injuries
- Abnormal hand and foot positions on newborn radiographs
- Lower limbs held in abnormal positions
- Two names people constantly mix up
- Early pregnancy renal anhydramnios
- The causes grouped under one heading
How common, and who is at risk
Registry numbers, and what shifts the odds
- 1 in 4000
- Why the live birth number is so much lower
- Who is affected more often
- Modifiable risks from the birth defects study
What travels with it
Associated anomalies, chromosomes and inherited risk
- Other malformations are common
- Left-right patterning goes wrong too
- Chromosomes and named syndromes
- The genetic workup to offer
- How a kidney is normally built
- Stages of embryonic kidney development
- Where the process can fail
- What else is missing alongside the kidneys
- It can run in families
- 5%-6%
- The renal hypodysplasia/aplasia spectrum
- The four listed RHDA types
- How to read that genetics table
- The signalling pathway underneath
Finding it on ultrasound
Absence is hard to see - so you look for it systematically
- What normal fetal kidneys look like
- Transverse view through the fetal trunk
- 99%
- Detection is excellent, but usually late
- The first clue: the fluid is gone
- Where to look when the fluid is low
- An empty fetal bladder between the umbilical arteries
- Telling adrenal gland from kidney
- Adrenal gland capping the kidney
- The lying-down adrenal sign
- Adrenal gland filling the empty renal fossa in three planes
- Flattened adrenal lying in the renal fossa
- Colour Doppler gives the clinching sign
- Renal arteries branching from the aorta
- How to set up the Doppler view
- Renal arteries present, and then absent, on colour Doppler
- Aorta with no renal branches leaving it
- Before 16 weeks the diagnosis is harder
- The three classic signs
- Where MRI fits in
- What MRI shows when it is done
What else it could be
Three groups to work through before committing to the diagnosis
- Group one: syndromes that include renal agenesis
- Group two: kidneys present but abnormal
- Group three: no fluid, so you cannot tell
- Sorting out a fetus with no amniotic fluid
Counselling and treatment
A lethal anomaly, and a therapy that is still an experiment
- Why prenatal detection still matters
- The 2014 case report that started it
- The caution that came straight after
- Why the field moved to a formal trial
- What RAFT found about renal agenesis
- How the fetal therapy story unfolded
- Where that leaves practice today
- What the referring physician needs to know
Summary
Three cards to carry away
- Takeaways: the condition
- Takeaways: the scan
- Takeaways: what to tell the family
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition