Healthy kidneys clean and remove waste from our blood. When a baby's kidneys and urinary tract don't develop during pregnancy, it can lead to kidney disease before birth. If the baby's kidneys stop working completely, the condition is called fetal end-stage kidney disease (FESKD).
FESKD: Why Choose Us?
The Fetal Care Center is one of the few centers in the country that provides the full range of care—from diagnosis to complex fetal surgeries and interventions for rare fetal conditions such as FESKD—all on one campus.
About FESKD
FESKD is a rare disease that occurs in babies with congenital anomalies of the kidneys and urinary tract (CAKUT), a genetic condition in which a baby’s kidneys and urinary tract do not develop normally. In severe cases of CAKUT, the kidneys can stop working almost entirely and cause FESKD.
Babies with low kidney function don’t produce enough urine, which is a main source of amniotic fluid. Without that fluid surrounding them, a baby’s lungs are underdeveloped and they have difficulty breathing independently after birth. While babies with FESKD will eventually need a kidney transplant, there are other therapies that can be used until a transplant is possible to allow babies to live a healthy life.
Causes of Fetal End-Stage Kidney Disease
FESKD can occur in babies when their mothers have severe hypertension, preeclampsia, whole-body diseases, infections, or rare genetic conditions.
Parents can undergo genetic testing and counseling at the Fetal Care Center. Our experts can help you understand the causes of CAKUT and how it may impact any future pregnancies.
Diagnosing Fetal End-Stage Kidney Disease
Using fetal ultrasound, echocardiogram, and MRI imaging, WashU Medicine experts at the Fetal Care Center will assess the severity of the kidney damage and examine for other potential fetal conditions. They’ll then collaborate to create a plan for the remainder of your pregnancy and postpartum care.
Treating Fetal End-Stage Kidney Disease
WashU Medicine maternal-fetal care specialists and sonographers can perform several minimally invasive procedures at the Fetal Care Center for patients expecting a baby that’s been diagnosed with CAKUT or FESKD. The care team will recommend which procedure(s) are best for you and your baby:
Vesicocentesis: Urine is drained from the baby’s bladder to check for blockages and assess overall kidney function. A vesicocentesis is usually done during the second or third trimester.
Shunt placement: A vesicoamniotic shunt is placed inside the uterus to drain fluid from the baby’s bladder, treat blockages, and improve overall kidney function. The shunt is usually placed around the 16th week.
Amnioinfusion: Saline or other fluid is infused into the amniotic sac to replace the missing fluid and support fetal lung development during pregnancy. This is performed multiple times throughout the second and third trimester.
After the baby is born, they’ll receive specialized care in St. Louis Children’s Hospital’s Level IV newborn intensive care unit (NICU), the highest level of newborn intensive care in the region. The baby will be cared for by a team of WashU Medicine fetal kidney specialists and may receive dialysis and other supportive treatments to help them grow stronger while preparing for a kidney transplant.
Contact Us
To make an appointment with a WashU Medicine maternal-fetal medicine specialist at the Fetal Care Center, call 314-747-6539.