how to detect urinary tract anomaly from Fetus with ultrasound examination.

1. Urinary Track
Anomalies
dr.Ryan Saktika Mulyana, M.Biomed, SpOG
Maternal Fetal Medicine Udayana University
Bali

2. RINARYTRACKANOMALIE

3. KIDNEYThe fetal kidneys can be visualized on ultrasound in most cases by the end of the 1st trimester (12 weeks)
when they appear as two hyperechoic paravertebral structures in the 2nd trimester, they lose their hyperechoic appearance,
while by the 3rd trimester, it is possible to distinguish between the cortex And medula
Ginjal normal pada fetus
Usia kehamilan 13 minggu
Tampak ginjal sebagai
gambaran Hiperekoik
bilateral
pada regio paravertebra
(panah)
Ginjal normal pada fetus UK 18
minggu, ginjal tampak sedikit
hiperekoik dibandingkan dengan
sekitarnya. (panah), pelvis renalis
tampak di tengahnya
Ginjal fetus UK 28 minggu:
renal piramid menunjukkan
struktur hipoekoik di dalam
parenkim ginjal ;pelvis ginjal
terlihat sebagai daerah
ekofree di medialnya.
Ukuran pelvis tidak lebih dari 4mm
pada UK <32 minggu
Dan 7mm pada uk 33 minggu - term
Trismester 1 Trisemester 2 Trismester 3

4. RINARYTRACKANOMALIE

5. BLADDERBladder dapat dilihat segera setelah produksi urin bayi
dimulai pada usaia 10 minggu
Pada potongan aksial tampak dinding bladder ditunjukan dengan
tanda panah (ukuran tidak lebih dari 2-3mm) dan dengan color
doppler menunjukkan arteri perivesikal terpisah dan berjalan
mengelilingi bladder (panah)
URETERS & URETRAKedua struktur ini tidak tampak pada keadaan
normal.

6. DIFFERENTIAL DIAGNOSIS KELAINAN SALURAN KEMIH BAYI
Pendekatan sistematik terhadap saluran kemih bayi memerlukan penilaian USG kedua
ginjal, bladder dan jumlah amnion
Ginjal tidak Tampak Ukuran dan Echo ginjal Abnormal
completely absent
(unilateral agenesis)
ectopic
absent
(bilateral agenesis)
bladder cannot be
visualized
Oligohidramnios
16 minggu
common ectopic
site is represented
by the
pelvis, in the
presacral area or in
the iliac fossa
both kidneys bigger
and hyperechoic
polycystic kidneys
kidneys are small
and hyperechoic
Potter type IV
If the kidneys are
hyperechoic and
normal in size and
no associated
extrarenal
anomalies are
found

7. Ginjal Hyperekoik
Meningkat Normal Menurun
Volume
Polikistik Kidney Normal Varian
Kistik displasia
(Potter type 4)

8. Algorithm to be applied in
the case of calicopelvic
dilatation

9. Bladder tidak tampak
Ginjal
Tampak Tidak Tampak
Amnion (-)
Bilateral renal Agenesis
Echogenisitas
Normal
Echogenisitas
TIdak
Normal
Amnion
Normal
Amnion
menurun
Blader
ekstropia
Severe
FGR
Vol besar
AM (-)
Vol besar
AM (N)
Vol kecil
AM (-)
ARPKD ADPKD POTTER 4
Algorithm to be applied in the
case of non-visualization of
the bladder

10. The absence of both
kidneys is evident
despite the associated
oligohydramnios; the
arrows indicate both
adrenal glands in the
paraspinal regions.
Adrenal gland
the absence of both kidneys;
the right adrenal gland
appears enlarged
(arrowheads); the typical ‘ice
cream sandwich’ appearance
of the adrenal gland is
characterized by the
hypoechoic cortex and
hyperechoic medulla;
this is quite different from
the normal kidney.
typical ‘ice cream
sandwich’

11. Color doppler menunjukkan kedua arteri renalis
pada kasus ARPKD
Arteri renalis tidak tampak pada kasus bilateral
agenesis, aorta terlihat jelas, tanda panah
menunjukkan kelenjar adrenal

12. Color Doppler menunjukkan arteri renalis tunggal,
tanda panah menunjukkan singkle kidney tanpa
disertai pada area kontralateral
3D power Doppler pada kasus yang sama
menunjukkan arteri renalis (RA) merupakan cabang
dari aorta abdominal, tanda panah menunjukkan
hilangnya arteri renalis yang kontralateral. IA adalah
arteri iliaka komunis

14. Oblique scan through the fetal
pelvis. The kidney (arrows) is seen
within the pelvis, lying superior to
the bladder (BL).
Color flow Doppler shows the
pelvic kidney artery (arrow), which
originates from the aorta at a more
caudal level than the contralateral
renal artery (RA). K, pelvic kidney.
Crossed fused renal ectopia. Note the two fused
kidneys (arrows); the lower pole of the upper one is
fused with the upper pole of the lower one. In these
cases, the kidneys are also abnornally rotated, as in
horseshoe kidney

16. POLYCYSTIC AND DYSPLASTIC KIDNEYS

17. Conditions associated with
bright kidneys

19. Autosomal recessive polycystic kidney disease
(ARPKD) – Potter type I. (a) Axial scan through the
fetal abdomen showing the enlarged
hyperechoic kidneys (arrows). (b) Sagittal scan of
the fetal abdomen showing the increased
echogenicity of the liver due to cystic
fibrosis (arrowheads); the arrow indicates the
polycystic kidney.

20. In ARPKD, there is no clear separation
between cortex and medulla; thus the
kidney appears homogeneously
hyperechoic.
In ADPKD, on the other hand, there is a more evident differentiation
between the cortex and medulla. (b, c: 3D US with SRI) a b c

23. Axial scan through the fetal
abdomen showing an enlarged
right kidney (arrow) with multiple
cysts within the hyperechoic
parenchyma; the contralateral
kidney is normal.
Coronal scan through the fetal
abdomen showing an enlarged
kidney with increased echogenicity
and numerous non communicating
cysts.
Axial scan
through the fetal
abdomen showing 2
hyperechoic
enlarged kidneys and
multiple macrocysts.

26. Ultrasound image showing an enlarged
kidney with increased differentiation
between the cortex and the medulla.
The presence of some
macroscopic cysts
within the enlarged
kidney may represent
another ultrasound
variety of ADPKD.
3D surface rendering of
the same case as in (b).

29. Coronal scan through
the fetal abdomen showing
a hydronephrotic kidney with
echogenic parenchyma.
Ultrasound image
showing several
subcortical small cysts
(arrowheads). k,
kidney
Coronal scan of the fetal
abdomen showing a
distended urinary bladder
(BL) and hydronephrotic
kidneys with echogenic
cortex (arrows)

31. HYDRONEPHROSIS, HYDRO-URETERONEPHROSIS,
AND BLADDER DILATATION

35. Posterior urethral valve. (a) Ultrasound image showing the distended bladder with hydronephrosis and
dilatation of both ureters RD, right kidney; RS, left kidney; U, ureters; V, bladder. (b) The bladder is
distended and there is dilatation of the proximal part of the urethra (arrow)

36. Urethral atresia.
a. Ultrasound image showing
massive dilatation of the bladder
and hyperechoic kidneys.
b. Gross pathology shows a very
distended abdomen and small
chest. The lack of musculature
gives the abdominal wall a
flaccid, wrinkled appearance –
hence the name ‘prune belly
syndrome’

37. Figure 8.26 Sagittal scan through the
abdomen of a 13-week fetus showing mild
distension of the bladder and a dilated
posterior urethra
Figure 8.27 Rupture of an obstructed bladder
(arrow) may occur, producing urinous ascites,
as shown in this ultrasound image.

38. Megacystis microcolon intestinal
hypoperistalsis syndrome. Ultrasound image
showing megacyst, hydronephrotic kidneys,
and polyhydramnios (arrow).

40. Bladder exstrophy (a, b) Ultrasound images
showing an exteriorized bladder (arrows). (c)
3D surface rendering of the exteriorized
bladder (arrows). Associated hypospadias is
evident.

41. Ultrasound images showing several
different degrees of hydronephrosis.
a) The kidneys show moderate
pyelectasia.
b) Sagittal scan of a hydronephrotic
fetal kidney showing dilatation of
the pelvis and calices; the calices
are confluent and dilated.
c) Coronal scan of the kidney in a
case of ureteropelvic junction
(UPJ) obstruction; the renal
pelvis (RP) and caliceal
distension (arrows) end abruptly
at the ureteral junction.
d) Severe UPJ obstruction
presenting as an abdominal cyst;
the renal parenchyma is thinned
to a few millimeters.

43. Nephroblastoma. Axial (a) and coronal (b) scans of the fetal abdomen
showing a solid echogenic mass above the kidney (arrows).

46. (a) Ultrasound of the fetal genitalia, showing ambiguous genitalia: a small phallus (arrow) is seen between a heart-
shaped scrotal sac (scrotum bifidum), which mimics labia. (b) 3D surface rendering of the same finding. (c) External
genitalia at birth. (d) A bifid scrotum with hypospadias is evident in this scan. (e) The external genitalia at birth: the
urethral orifice and the incompletely fused scrotum are demonstrated.

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48. quiz

49. JAWABAN :
Unilateral Multycystic
Kidney Disease

50. JAWABAN :
Unilateral Multycystic
Kidney Disease

51. JAWABAN :
Unilateral Multycystic
Kidney Disease

52. JAWABAN :
Unilateral Multycystic
Kidney Disease

53. JAWABAN :
Unilateral Multycystic
Kidney Disease

54. JAWABAN :
Unilateral Multycystic
Kidney Disease

55. JAWABAN :
Unilateral Multycystic
Kidney Disease

56. JAWABAN :
Unilateral Multycystic
Kidney Disease

58. JAWABAN :
ARPKD (potter I)

59. JAWABAN :
ARPKD (potter I)

60. JAWABAN :
ARPKD (potter I)

61. JAWABAN :
ARPKD (potter I)

62. JAWABAN :
ARPKD (potter I)

64. JAWABAN :
ADPKD (potter III)

65. JAWABAN :
ADPKD (potter III)

67. JAWABAN :
Normal Kidney

68. JAWABAN :
Normal Kidney

69. JAWABAN :
Normal Kidney

70. JAWABAN :
Normal Kidney

72. JAWABAN :
Dilated Bladder
Post-urethral valve

73. JAWABAN :
Dilated Bladder
Post-urethral valve