Managing Fetal Kidney Cysts: What Parents Need to Know

What should be done if there are cysts in the fetal kidneys?

Hello Dr.
Chen,
I was referred to you as an expert in fetal treatment.
Due to work commitments, I haven't been able to schedule an appointment with you, but I am concerned about my child and would like to ask you some questions online.
My wife is 35 years old and is currently pregnant with our second child, a girl, at 23 weeks.
All checks have been normal so far, but during a recent ultrasound, we discovered that the right kidney of the fetus has a cyst.
Will this affect the baby after birth? We have consulted with a doctor at the Veterans General Hospital, who mentioned that this could potentially lead to loss of function in that kidney.
My wife is worried about the burden this may place on our child after birth and is considering termination if the situation is severe.
What would you recommend we do in this situation? Everything else appears to be normal with the fetus.
I hope you can guide us on the best course of action and the possible future developments (could the condition worsen?).
Thank you.

Malubao, 30~39 year old female. Ask Date: 2009/02/20

Dr. Chen Ming reply Rare Disease

This is a relatively common condition, especially in older mothers who should have undergone amniocentesis.
If the chromosomes are normal and there is unilateral hydronephrosis or pathology, as long as the other kidney is healthy, my opinion is that it is possible to continue the pregnancy.
I have encountered cases of hereditary conditions where several consecutive pregnancies have shown similar issues, but with varying degrees of severity.
If the current situation is not too severe, I recommend continued observation.

Reply Date: 2009/02/20

More Info

Managing fetal kidney cysts can be a source of anxiety for expectant parents, especially when faced with the uncertainty of potential complications. In your case, the discovery of a cyst on the right kidney of your 23-week-old fetus raises several important considerations regarding the health of your unborn child and the management of this condition.

Firstly, it is essential to understand that kidney cysts in fetuses are not uncommon and can often be benign. These cysts can vary in size and complexity, and their implications depend on various factors, including the type of cyst and whether there are any associated abnormalities. The most common type of cyst found in fetuses is a simple cyst, which typically does not affect kidney function or the overall health of the baby. However, more complex cysts, such as those classified as Bosniak type II or higher, may require closer monitoring and further evaluation.

The concern that the cyst may lead to the loss of kidney function is valid, but it is important to note that many fetuses with kidney cysts are born healthy and without significant complications. The potential for the cyst to affect kidney function depends on its size, location, and whether it is causing any obstruction to the urinary tract. If the cyst is large or causing hydronephrosis (swelling of the kidney due to urine buildup), it may warrant further investigation and monitoring.

In terms of management, it is crucial to maintain regular follow-up appointments with your healthcare provider, preferably a maternal-fetal medicine specialist who can provide specialized care for high-risk pregnancies. They may recommend additional ultrasounds to monitor the cyst's size and any changes in kidney function. If the cyst appears to be stable and there are no signs of complications, the healthcare team may suggest a conservative approach, allowing for continued monitoring until delivery.

If the cyst is determined to be complex or if there are concerns about kidney function, further diagnostic tests, such as MRI or amniocentesis, may be considered to gather more information. In some cases, fetal intervention may be necessary, but this is typically reserved for severe cases where the cyst poses a significant risk to the fetus's health.

Regarding your concerns about the potential burden on your child after birth, it is important to remember that many children with kidney cysts lead normal, healthy lives. Postnatal management may involve additional imaging studies to assess kidney function and determine if any intervention is needed. In rare cases where significant kidney damage is present, surgical options may be explored, but this is not common.

In conclusion, while the discovery of a kidney cyst in your fetus can be concerning, it is essential to approach the situation with a focus on careful monitoring and collaboration with your healthcare team. Regular follow-ups and open communication with your doctors will help ensure that any potential issues are addressed promptly. It is also important to consider the emotional aspect of this journey; seeking support from family, friends, or counseling services can be beneficial as you navigate this experience. Ultimately, many children with kidney cysts thrive, and with appropriate care, your child can have a healthy start to life.

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