I went for a consultation with a pediatric urologist today, to discuss the Statesman's problem. This is something I have felt would be helpful from the very beginning, even after our first ultrasound, which showed an abnormal prenatal kidney finding.
The pediatric urologist was a very pleasant middle-aged man. I was seen promptly, and aside from the overtly sexual images of Wonder Woman in the waiting room (seriously? I guess I didn't actually know what she looked like), I would highly recommend the whole outfit.
First of all, a little history on this problem, beginning with our 20-week ultrasound.
Diagnosis #1: Possibly Down's Syndrome, more likely Trisomy-18, or it could be an isolated problem with the kidneys. It might resolve before birth, or the baby might die before birth, or your child may be seriously disabled forever.
Treatment Options: Nothing, except freak out.
My Brain On Diagnosis #1: Sweaty brow, shallow breathing, hands wringing. Or was that just my low blood sugar?
Diagnosis #2: This is probably not a chromosomal defect, and more likely just a kidney problem. The baby's growth looks great, but we still need you to come in all the friggin' time just in case we decide not to do anything about it.
Treatment Options: Nothing, except freak out.
My Brain On Diagnosis #2: Phew. I knew this was probably all overblown. Now to get on with life...
Diagnosis #3: We were confident all along that you would never be able to have three healthy pregnancies as a Type I diabetic woman and it turns out that you have, indeed, transmitted a serious problem to your child. Even though your A1Cs were very good, you still weren't controlling your blood sugars well enough to keep those nasty birth defects away.
Treatment Options: Nothing, except freak out AND wallow in guilt about some of the high blood sugars I had early in pregnancy.
My Brain On Diagnosis #3: Shooooooot. Now my endocrinologist will have even more reason to psychologically sucker punch me every time I come into the office. And, even though my little man will almost certainly be fine, wouldn't life be better with two kidneys?
Well, besides getting an excellent lesson in kidney anatomy and physiology today, we also got a new diagnosis. Based on the same images that the maternal-fetal specialist looked at, the pediatric urologist thinks it's something very different! He led the consultation by describing how this may be a variation of normal development (a large, relaxed renal pelvis) or a result of the hormonal milieu of my body (hormones causing the tissues to relax or constrict). Lastly, he mentioned that the dilation may be from an anatomical blockage of the ureteropelvic junction. This kind of blockage is more common in little boys, and it frequently resolve as the child grows older. They only infrequently require surgery to correct.
He thought MCDK was extremely unlikely, because he did not see cysts within the renal cortex. In fact, he saw an apparently anatomically typical renal cortex on the "affected side," which made him think it was probably a functional kidney. He was especially reassured by the good amniotic fluid measurements. He ruled out some other problems based on the normal size of the bladder and the ureter.
I think I have good reason to trust the pediatric urologist's judgment over that of the maternal-fetal specialist, and not just because it makes me feel like a better mother. Most notably, pediatric urologists have probably seen dozens (or even hundreds) of ultrasounds of kidneys affected by a variety of abnormalities. On the other hand, given how uncommon they are in the general population (MCDK is only found in 1 out of every 4000 or 5000), a maternal-fetal specialist might only have seen one, or none at all.
So, we have a new chapter in this little baby's history.
Diagnosis #4: Most likely a variation of normal, possibly a small anatomical defect that may not even require surgery to correct.
Treatment Options: Nothing, except feel good about what a healthy baby you've grown and look forward to your son's future as a potential kidney donor.
My Brain On Diagnosis #4: Aaaaaah.
After he's born, the Statesman will have his own kidney and bladder ultrasound, and will probably be on prophylactic antibiotics to prevent urinary tract infection (I don't know how long). From the ultrasound we'll be able to see if there are any problems significant enough to warrant an intervention like surgery, but that sounds increasingly unlikely.
I have another ultrasound on Friday, but I doubt we'll receive any more earth-shattering news. I also doubt that I'm going to let them freak me out about that kidney one more time! I'll keep you posted.
What a life he's had so far! The Statesman, thanks to his patron saint and all our friends and family who have been interceding for us, has bolstered our faith and confidence in God's providence. In the uncertainty of the diagnosis, we prepared for a crown of thorns and a cup of bitter gall, but instead we have been anointed with oil and fed with milk and honey. Thank you!