Prenatal Screening for Kidney and Urogenital Malformation

Innovations in Pediatric Nephrology | Special Issue October 2020

Preemptive nephrology consultation at UH Rainbow Babies & Children's offers parents expertise, reassurance and a coordinated care plan

When a routine prenatal ultrasound flags a potential problem, expectant parents are anxious for information. Renal system abnormalities, including complications of the kidneys, bladder, ureters or urethra, account for 15 to 20 percent of all congenital anomalies. Fortunately, the experts at University Hospitals Rainbow Babies & Children’s Hospital are available to offer consultation and answer questions before babies are born.

Christina Nguyen, MD

“Worried parents are quick to assume their baby will have kidney failure or require dialysis, but that is often not the case,” says Christina Nguyen, MD, Division Chief of Pediatric Nephrology at UH Rainbow Babies and Children's Hospital and Clinical Assistant Professor at Case Western Reserve University School of Medicine. “Prenatal consultation helps relieve those anxieties and gives parents an idea about what to expect in the first few weeks and months of life.”

Dr. Nguyen came to University Hospitals in the summer of 2019 to expand the reach of UH Rainbow Babies & Children’s Hospital’s nationally ranked pediatric nephrology program. “My passion is taking care of kids with chronic kidney disease and helping them receive the proper care to live long, successful lives,” says Dr. Nguyen.

She collaborates with an expert multidisciplinary team to diagnose, treat and manage kidney disease and complex urogenital conditions, including:

• Genetic complications and inherited kidney disease
• Development of a single kidney
• Hydronephrosis
• Urogenital malformations or blockages
• Polycystic kidney disease
• Acute kidney injury

For patients requiring the highest level of care, experienced specialists offer transplantation with excellent outcomes. “As a transplant center, we are progressive in the belief that children benefit from the earliest possible transplantation that they can receive,” says Dr. Nguyen. “We strive to do dialysis-preemptive transplantation whenever we can, but we constantly want to be moving toward a kidney transplant when that is the best option for a child.” Additionally, a full spectrum of renal replacement therapy is available, including hemodialysis, peritoneal dialysis and continuous renal replacement therapy.

FROM PRENATAL CONSULT TO PROMISING FUTURE

“My first month here, we offered a prenatal consult with a mother after ultrasound detected multiple congenital anomalies, including kidney cysts, oligohydramnios and insufficient fetal development,” says Dr. Nguyen. “We explained to mom the requirements the baby would need at birth for us to provide care.” One of the key markers was a birthweight of at least 1.8 kilos. Weighing 1.9 kilos, the baby boy began dialysis on day three of life and is awaiting transplantation in the coming months. His care team has included nephrologists, urologists, pediatric surgeons and neonatologists working in concert. “What this team has accomplished for this baby is absolutely amazing,” says Dr. Nguyen. “He had every reason for a million things to go wrong but, with optimal care, he is growing and thriving. It is nothing short of a miracle.”

HELPING FAMILIES PREPARE

Today’s prenatal ultrasonography offers a highly accurate indication of underlying conditions and prognosis. If there are concerns, serial ultrasounds enable practitioners to closely monitor the pregnancy. “Many times, we are providing anticipatory guidance and education,” says Dr. Nguyen. “Keeping parents plugged in, both early and longitudinally, is important in the care of complex kidney conditions.” Even emphasizing simple routines like correct car seat usage is critical because motor vehicle accidents are the most common cause of loss of kidney.

It is also essential to have a skilled support team in place to treat the whole child. These patients often face neurocognitive delays, challenges in school and short stature, affecting their feelings of self-esteem. “We rely on our psychologists, social workers and nutritionists to help these kids succeed and tackle challenges that come their way,” says Dr. Nguyen.

REACHING INTO THE COMMUNITY

With physician offices spread throughout Northeast Ohio, UH Rainbow Babies & Children’s Hospital is meeting families in their communities. “What I love about UH is the congeniality,” says Dr. Nguyen. “People here genuinely want to help each other—and they want to help the children of Cleveland.”

Contact Dr. Nguyen at Christina.Nguyen@UHhospitals.org or to make an appointment with a pediatric nephrology spcialist call, 216-844-PEDS (7337).