1. The Management of antenatal pelviectasis – are we there yet? Malcolm A. Lewis Consultant Paediatric Nephrologist RMCH

2. The Management of antenatal pelviectasis – are we there yet? No Thank you, Time for me to leg it!

3. The Management of antenatal pelviectasis – are we there yet? Lies – damn lies – and statistics (?Disaeli) Clinical trials, follow up studies, RCT’s, registry data

4. The Management of antenatal pelviectasis – are we there yet? and the result of all this is…. we have become slaves to statistics

5. The Management of antenatal pelviectasis – are we there yet? but what does this curve really mean?

6. The Management of antenatal pelviectasis – are we there yet? but what does this curve really mean? SHIT HAPPENS

7. The Management of antenatal pelviectasis – are we there yet? Patient WH. Antenatal scans left pelvic dilatation TPD 12 mm Postnatal scans;- 9 mm

8. The Management of antenatal pelviectasis – are we there yet? Patient WH. Antenatal scans left pelvic dilatation TPD 12 mm Follow up 09/06/2009 – age 13 months;- 5.7 mm

9. The Management of antenatal pelviectasis – are we there yet? Patient WH. Antenatal scans left pelvic dilatation TPD 12 mm Follow up 22/06/2010 – age 24 months;- 37.3 mm

10. The Management of antenatal pelviectasis – are we there yet?

11. Pathophysiology of antenatal renal tract dilatation Conditions associated with renal tract dilatation Investigation and follow up

12. The Management of antenatal pelviectasis – are we there yet? Pathophysiology of antenatal renal tract dilatation Fetus is in a state of diuresis 7.5 ml/hr at 25 weeks gestation = 10 ml/kg/hr 10 ml/hr at 30 weeks gestation = 7.7 ml/kg/hr 27 ml/hr at 40 weeks gestation = 7.7 ml/kg/hr Postnatal urine production rate up to 2 - 6 ml/kg/hr Renal tract elastic so stretching possible

13. The Management of antenatal pelviectasis – are we there yet? Conditions associated with renal tract dilatation Single kidney (agenesis, MCDK) Pelviectasis, pelvi-ureteric junction obstruction Hydro-ureter, vesico-ureteric junction obstruction Vesico-ureteric reflux Bladder outlet obstruction, posterior urethral valves Duplex systems with ureterocoele

14. The Management of antenatal pelviectasis – are we there yet?

21. Investigation and follow up What exactly was seen antenatally? 7 mm8.5 mm

22. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up What exactly was seen antenatally?

23. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up What exactly was seen antenatally?

24. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up What exactly was seen antenatally?

25. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up Isolated unilateral pelviectasis –Is the contralateral kidney normal? –What is the size of the renal pelvis (TPD)? –Are the calyces dilated? –Is the kidney big or small? –Is there a ureter visible?

26. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up Isolated unilateral pelviectasis –Is the contralateral kidney normal? If yes, chill, if no find the Jewish mother (or nephrologist) –What is the size of the renal pelvis (TPD)? 15 mm renogram, between follow –Are the calyces dilated? May mean obstruction or dysplasia, go to next question! –Is the kidney big or small? If big then more likely to be obstructed –Is there a ureter visible? If yes could be reflux or VUJO or combination

27. The Management of antenatal pelviectasis – are we there yet? Investigation and follow up Bilateral pelviectasis –MCUG –and then…..

28. The Management of antenatal pelviectasis – are we there yet? So when can we make a diagnosis?

29. The Management of antenatal pelviectasis – are we there yet? So when can we make a diagnosis?

30. The Management of antenatal pelviectasis – are we there yet? So what can we say about antenatal pelviectasis Start worrying…………… details to follow The Jewish mother’s telegram (? Text now)