Fetal pyelectasis

Fetal pyelectasis (FP) refers to a prominence / dilatation or the renal pelvis in utero. It is the mild end of the fetal hydronephrosis spectrum.

Epidemiology

Fetal pyelectasis can be a relatively common finding in an antenetal ultrasound scan, often detected at the routine 2^nd trimester morphology scan. There is a recognised male predilection. The estimated prevalence is at ~ 2% of routine second trimeter scans ¹³.

Pathology

Pyelectasis can result from a number of factors. In the majority of cases, it is physiological and resolves spontateously. However, it may also herald the presence or evolution of renal tract pathology, such as :

• fetal PUJ obstruction
• fetal VUJ obstruction
• urethral obstruction - e.g. posterior urethral valves
• vesicoureteric reflux
• duplex kidney

Associations

• trisomy 21: presence and strength of this association is currently under debate and at best considered very mild.

Radiographic assessment

Antenatal ultrasound

Fetal pyelectasis is assessed on axial plane ultrasound through the fetal renal pelvices. It is considered present if measurements are above the levels stated below

• > 4 - 4.5 mm at 18 - 20 weeks (i.e. the routine 2^nd trimester)
• > 5 mm at ~ 20 - 29 weeks
• > 6 mm at 32 weeks
• persistent fetal pyelectasis : > 7 mm in the 3^rd trimester ⁸

^{* Different publications state the values differently for gestational ages. If you an expert on this we would love your help :)}

Fetal pyelectasis can also be affected by maternal hydration - physiological fetal pyelectasis ⁵.

Significance

The vast majority of cases (~ 96%) with mild pyelectasis in the second trimester resolve, either during pregnancy or in the early postpartal period. The risk of post-natal renal pathology is increased with : 

• increasing degree of pelvic dilatation
• in-utero progression
• bilateral involvement

The presence of fetal pyelectasis is sometimes considered a soft sign for chromosomal abnormalties : see associations above

Antenatally detected renal pelvic dilatation, especially in isolation, is considered a weak predictor of vesicoureteric reflux ⁷ although postnatal sonographic evaluation is often recommended.

Prognosis

Some advocate a repeat prenatal scan at 30 - 40 weeks gestation for all fetuses with 6 mm or more of renal pelvic dilatation is detected prior to 28 weeks as well as postnatal follow-up for persistent pyelectasis ¹⁰.

Post natally, most cases with pyelectasis resolve spontaneously in the first year of life and invasive procedures are not required. More content required

See also

• fetal hydronephrosis