When expectant parents hear that their developing baby is in fetal renal failure and their kidneys are not working properly they can feel scared and overwhelmed. The Stanford Medicine Children’s Health Fetal and Pregnancy Health Program provides multidisciplinary evaluation and innovative care management for fetal renal failure. For some patients, we are able to give a baby a chance at life or normal kidney function that did not exist before.
Q: What is fetal renal failure?
A: Fetal renal failure is when a baby’s kidneys do not form correctly in the womb. The fetal renal conditions we treat within Stanford Children’s Fetal and Pregnancy Health Program include a group of rare and complex kidney birth malformations called congenital anomalies of the kidney and urinary tract (CAKUT). This includes kidneys that never develop (bilateral renal agenesis), kidneys that may not function as expected because they did not form normally (renal dysplasia), a blockage in a fetus’s urinary tract (lower urinary tract obstruction (LUTO), and early renal anhydramnios (see below).
Q: What is early renal anhydramnios, a type of in-utero renal failure?
A: Early onset renal anhydramnios is a fetal condition where the kidneys aren’t functioning or even present starting at 16-20 weeks gestation (including renal agenesis). In such cases, there is a lack of amniotic fluid very early in gestation which prevents the lungs from developing normally. This condition is associated with a very high risk of death after birth. At Stanford Children’s our goal is to evaluate such pregnancies as early as possible, try to understand the underlying reason, and potentially treat such cases in order to increase the likelihood the child can survive.
Q: What research have you completed on treating early renal anhydramnios with amnioinfusions and how has it changed your treatment approach?
A: We recently completed the innovative RAFT Trial, which has shown that some children with early onset fetal renal failure can undergo serial amnioinfusions (repeated injections of fluid into the uterus during pregnancy). In some of the clinical trial’s cases, children survived to dialysis and renal (kidney) transplant. Because the clinical trial proved to give some children a chance at life, we are now offering serial amnioinfusions to our patients whose pregnancies are complicated by early onset anhydramnios due to bilateral renal agenesis (when both of the fetal kidneys are missing) or early fetal renal failure, such as cystic renal disease (when cysts form on the developing kidneys).
Q: How do you determine which patients are a good fit for amnioinfusions?
A: We use strict criteria to determine whether someone is eligible for serial amnioinfusions. This includes criteria for the fetus, the mother, and for the pregnancy. Each pregnant patient undergoes a very rigorous evaluation and multidisciplinary consultation to determine eligibility. We are also a part of the North American Fetal Therapy Network RAFT registry, which aims to learn even more about serial amnioinfusions for fetal renal failure, empowering us to stay on the leading edge of care.
Q: What outcomes can patients expect when coming to Stanford Children’s for amnioinfusions?
A: Predicting outcomes in these very complex cases is challenging. That said, patients can expect multidisciplinary evaluations and management regardless of intervention. They can also expect a dedicated team that is with them during the entire maternal-fetal-neonatal and pediatric care continuum, and they can expect a care plan that does everything possible to keep the mother safe and achieve the best possible outcome for the baby.
Q: Why should patients choose Stanford Children’s for fetal renal failure/early renal anhydramnios care?
A: We were one of the most active participants in the RAFT Trial, and were involved in the development of approaches and techniques that have led to many successful outcomes. We have nationally ranked and robust expertise and experience in imaging, maternal care, neonatal care, genetics, as well as pediatric surgery, pediatric nephrology, dialysis and kidney transplant, and urology – all working together as one team to provide babies their best chance at a good outcome. Finally, we are dedicated to providing outstanding, equitable, and supportive care to all our patients and their families, regardless of resources or ultimate decisions about interventions or socio-economic background.
Q: What can patients expect when getting amnioinfusions?
A: Even though amnioinfusions may be perceived as relatively simple ultrasound-guided needle procedures, they demand a careful, safe approach. We typically perform amnioinfusions in an operating room (OR) setting using sterile procedures to reduce the likelihood of infection, with specialized obstetric anesthesia support to make sure the mother is safe and pain-free. Partners, and other family members, may be able to join us in the OR to provide support to their loved one. Finally, we communicate with our patients throughout the entire procedure so that they know exactly what is happening the entire time.