Renal Pyelectasis on Prenatal Ultrasound – Next Steps?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Define renal pyelectasis 2. Summarize the management of a pregnancy with renal pyelectasis identified at the anatomical study
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Renal pyelectasis literally means “pelvis dilation” of the kidney, and is defined as an anteroposterior diameter of the renal pelvis of ≥ 4mm up to 20 weeks of gestation.
CLINICAL ACTIONS :
When seen in isolation, with no other fetal abnormalities
If aneuploidy screening has not yet been done, then screening or diagnostic testing should be offered
If patient opts for aneuploidy testing and result is negative, no further evaluation is required
Counsel patients that screening tests are not diagnostic and therefore there is still residual risk for chromosomal anomalies
If aneuploidy screen result is positive, refer for genetic counseling and consideration of diagnostic testing options
Ultrasound at 32 weeks of gestation is suggested to rule out persistent pyelectasis and possible obstruction of the urinary tract
If the renal pelvis is > 7 mm at 32 weeks, then post-natal follow up is suggested
If other anomalies are detected
ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
Renal pyelectasis is reported in 0.6-4.5% of fetuses in the second trimester. It is most commonly a transient physiologic state in which the renal pelvis, the structure that is essentially the funnel for urine exiting the kidney into the ureter, is dilated and measures larger than what is considered normal for a particular gestational age. The presence of renal pyelectasis as an isolated finding, in the setting of a negative aneuploidy screen, is not itself an indication for invasive testing; however, ACOG does give all women the option (both high and low risk) for invasive testing. Note, if the renal pelvis is still dilated in the third trimester, the urinary tract may require attention following delivery to ensure normal kidney function and prevent infection in the newborn.
Normal renal pelvis measurement is up to 1cm throughout gestation
Values above 1cm are almost always pathological
Resolution of dilation based on second trimester measurement
Between 4 and 7 to 8 mm: 80% resolution
>9 mm: <15%
More commonly observed in male fetuses
A targeted ultrasound is essential to look for other fetal anatomic anomalies
Note: ACOG guidance recommends offering invasive, diagnostic testing for all pregnant women regardless of age and even in the presence of a normal anatomy scan
Offering invasive testing using microarray in the setting of fetal structural anomalies on prenatal ultrasound is recommended
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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