Hyperechogenic Fetal Kidneys: Uncertain Diagnosis and Unpredictable Future?
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ORIGINAL ARTICLE
Hyperechogenic Fetal Kidneys: Uncertain Diagnosis and Unpredictable Future? Gupta Ashutosh1 • Aneja Anjila2 • Bahl Neena2 • Arora Rupam3 Sehgal Renu Raina4 • Saini Pankaj5
•
Received: 2 June 2020 / Accepted: 10 August 2020 / Published online: 18 September 2020 Ó Society of Fetal Medicine 2020
Abstract Glomerulocystic kidney with increased renal echogenicity encompasses a number of renal abnormalities that might have cystic glomeruli and be a sequelae of renal obstruction. Increased echogenicity of the kidneys is a nonspecific finding and a result of varied etiologies. Multiple microscopic cortical and medullary cysts, interstitial fibrosis and mesangial sclerosis are the etiopathogenesis for renal hyperechogenicity even in the absence of macrocysts. The crucial point is poor predictability of antenatal
& Gupta Ashutosh [email protected] Aneja Anjila [email protected]
ultrasound to fully define the extent and severity of parenchymal damage and to forecast its outcome at the time of initial diagnosis. The only exception is the most severe forms of cystic dysplasia associated with severe oligohydramnios. Urinary levels of b2-microglobulin may be a valuable marker of fetal renal function. Hyperechogenic fetal kidneys may have varied etiologies and within each etiological group there may have a wide range of outcomes. Challenges lie in counseling after antenatal diagnosis of fetal hyperechogenic kidneys which carry an uncertain course and prognosis. Keywords Hyperechogenicity Poor predictability Parenchymal damage b2-Microglobulin Challenge Counseling
Bahl Neena [email protected] Arora Rupam [email protected]
Normal Renal Echogenicity
Sehgal Renu Raina [email protected]
Normal fetal kidneys are isoechoic with fetal liver or just a little less echogenic than fetal liver after 17 weeks of gestation. Increased echogenecity is identified in the second or third trimester of pregnancy when renal parenchymal echogenecity is greater than that of the liver beyond 17 weeks of gestation. Echogenecity is assessed subjectively by comparing the overall echogenecity of the renal parenchyma and not the components of renal structure individually. Care should be taken to adjust gain settings on the ultrasound machine appropriately. In a doubtful situation, harmonics should be turned off for this assessment. This is necessary to reduce intraobserver and interobserver variations that are inherent to any subjective assessment. The normal arrangement of glomeruli in the renal cortex and the distribution of tubules in the medulla is the basis for normal corticomedullary differentiation [1]. The
Saini Pankaj [email protected] 1
Foetal Medicine and Medical Genetics, Artemis Hospitals, Sector 51, Gurgaon 122001, India
2
Department of Minimal Access Surgery (Gynaecology), Fortis Memorial Research Institute, Gurgaon, Sector 44, Gurgaon 122001, India
3
Department of Obstetrics and Gynaecology, Max Balaji Hospital, 108 A, Indraprastha extension, Patparganj, New Delhi
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