# Oligohydramnios — GCMD Library living collection

Everything in the library about oligohydramnios — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 94 cited statements

## Episodes
### Diagnosis & Workup
- [Fetal Diagnostic Imaging: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744) — video · 10:34 · [machine version](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744.md)

### Medical Management
- [Fetal management of advanced chronic kidney disease: Fetal Genitourinary...](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916) — video · 34:05 · [machine version](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916.md)

### Long-Term Care
- [Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622) — video · 35:10 · [machine version](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=0) Pulmonary Survival in Neonates with Bladder Outlet Obstruction (Ep 1)
- [7:31](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=451) Managing Advanced Chronic Kidney Disease in Fetal Center Graduates (Ep 1)
- [26:41](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1601) Clinical Decision-Making and Nutritional Management (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0) Amnioinfusion technique for fetal bladder outlet obstruction evaluation (Ep 2)
- [3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180) Ultrasound imaging findings in genitourinary abnormalities (Ep 2)
- [8:38](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=518) Kidney size, diaphragmatic excursion, and role of MRI (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=0) Pulmonary Survival in Fetal Genitourinary Disease (Ep 3)
- [6:10](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=370) Case Presentation: Severe Posterior Urethral Valves with Recovery (Ep 3)
- [12:43](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=763) Medical Management of Advanced Chronic Kidney Disease in Infants (Ep 3)
- [17:35](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1055) Chronic Kidney Disease Staging and Guidelines in Infants (Ep 3)
- [21:03](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1263) Dialysis Indications and Transplant Planning (Ep 3)
- [25:35](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1535) Q&A: Pulmonary Prognosis, Peritonitis Management, and Nutrition (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%." — Paul Kingma (clinical) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=162)
- "If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor." — Paul Kingma (clinical) [Ep 1 · 3:08](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=188)
- "Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured." — Paul Kingma (clinical) [Ep 1 · 5:33](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=333)
- "Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint." — Paul Kingma (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=360)
- "Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites." — Jan Scober (clinical) [Ep 1 · 10:32](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=632)
- "Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine." — Jan Scober (clinical) [Ep 1 · 11:03](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=663)
- "Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction." — Jan Scober (clinical) [Ep 1 · 15:37](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=937)
- "Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100." — Jan Scober (clinical) [Ep 1 · 19:48](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1188)
- "Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function." — Jan Scober (clinical) [Ep 1 · 20:14](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1214)
- "The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR." — Jan Scober (guideline) [Ep 1 · 20:42](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1242)
- "Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed." — Jan Scober (clinical) [Ep 1 · 22:42](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1362)
- "Peritoneal dialysis is the technically least difficult way to provide dialysis in small children." — Jan Scober (clinical) [Ep 1 · 23:27](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1407)
- "Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis." — Jan Scober (clinical) [Ep 1 · 25:17](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1517)
- "At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life." — Jan Scober (clinical) [Ep 1 · 13:24](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=804)
- "Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies." — Jan Scober (clinical) [Ep 1 · 13:53](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=833)
- "Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies." — Jan Scober (clinical) [Ep 1 · 14:52](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=892)
- "If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period." — Paul Kingma (clinical) [Ep 1 · 27:46](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1666)
- "If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents." — Paul Kingma (clinical) [Ep 1 · 28:15](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1695)
- "The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis." — Paul Kingma (clinical) [Ep 1 · 28:44](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1724)
- "When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels." — Jan Scober (clinical) [Ep 1 · 30:04](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1804)
- "Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems." — Jan Scober (clinical) [Ep 1 · 30:22](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1822)
- "Temporary hemodialysis catheters in newborns are difficult to maintain because there is not much catheter design for small children, resulting in excess extravascular catheter that moves despite securing, and the 8 French catheter is limited to jugular veins." — Maria Alonso (clinical) [Ep 1 · 31:27](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1887)
- "Tunneled hemodialysis catheters are easier to maintain from a movement standpoint but are still very large and likely to cause local thrombosis or stenosis in the central circulation." — Maria Alonso (clinical) [Ep 1 · 31:53](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1913)
- "Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated." — Jan Scober (clinical) [Ep 1 · 32:34](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1954)
- "High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients." — Jan Scober (clinical) [Ep 1 · 32:49](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1969)
- "The density of formula is essentially an inverse function of urine output." — Jan Scober (clinical) [Ep 1 · 33:12](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1992)
- "The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise." — Jan Scober (clinical) [Ep 1 · 33:50](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2030)
- "It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition." — Jan Scober (clinical) [Ep 1 · 34:15](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2055)
- "Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it." — Jan Scober (clinical) [Ep 1 · 34:31](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2071)
- "The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration." — Jan Scober (clinical) [Ep 1 · 34:45](https://library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2085)
- "In fetal genitourinary disease, pulmonary survival is the critical first question that determines whether renal outcomes matter, yet it is frequently overlooked in discussions focused on kidney function." (opinion) [Ep 3 · 0:28](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=28)
- "When amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases significantly to approximately 80%." (clinical) [Ep 3 · 1:36](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=96)
- "If amniotic fluid levels are not returned to normal despite intervention, pulmonary outcomes are poor." (clinical) [Ep 3 · 2:03](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=123)
- "Determining pulmonary survivor status after delivery is complex because multiple postnatal factors can affect outcomes: sepsis-related lung injury, nutritional status affecting lung growth, and ventilator-induced barotrauma." (clinical) [Ep 3 · 3:12](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=192)
- "Being a pulmonary survivor does not mean normal respiratory function; many infants have reduced lung reserve similar to reduced renal reserve and can rapidly decompensate with additional injury." (clinical) [Ep 3 · 4:27](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=267)
- "Some infants with prenatal renal problems who had amniotic fluid replacement and normal fluid levels still developed chronic lung disease after delivery, demonstrating they are not respiratory-normal." (clinical) [Ep 3 · 4:51](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=291)
- "Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management." — Jan Scober (clinical) [Ep 3 · 9:26](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=566)
- "Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid." — Jan Scober (clinical) [Ep 3 · 9:46](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=586)
- "Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs." — Jan Scober (clinical) [Ep 3 · 12:48](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=768)
- "Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies." — Jan Scober (clinical) [Ep 3 · 13:40](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=820)
- "Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction." — Jan Scober (clinical) [Ep 3 · 14:33](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=873)
- "Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects." — Jan Scober (clinical) [Ep 3 · 15:13](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=913)
- "Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children." — Jan Scober (clinical) [Ep 3 · 15:47](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=947)
- "Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation." — Jan Scober (clinical) [Ep 3 · 16:03](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=963)
- "Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia." — Jan Scober (clinical) [Ep 3 · 16:20](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=980)
- "Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support." — Jan Scober (clinical) [Ep 3 · 16:44](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1004)
- "Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year." — Jan Scober (clinical) [Ep 3 · 18:25](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1105)
- "Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR." — Jan Scober (host_summary) [Ep 3 · 19:36](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1176)
- "Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis." — Jan Scober (host_summary) [Ep 3 · 20:37](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1237)
- "The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone." — Jan Scober (clinical) [Ep 3 · 21:39](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1299)
- "Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children." — Jan Scober (clinical) [Ep 3 · 22:22](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1342)
- "Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home." — Jan Scober (clinical) [Ep 3 · 23:04](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1384)
- "When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package." — Jan Scober (opinion) [Ep 3 · 23:26](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1406)
- "Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job." — Jan Scober (clinical) [Ep 3 · 23:47](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1427)
- "Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis." — Jan Scober (clinical) [Ep 3 · 24:11](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1451)
- "It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging." — Jan Scober (opinion) [Ep 3 · 24:26](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1466)
- "At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life." — Jan Scober (clinical) [Ep 3 · 12:29](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=749)
- "For aggressive pulmonary care in infants with genitourinary disease, whatever respiratory support is needed should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period." (clinical) [Ep 3 · 26:40](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1600)
- "If an infant is not showing signs of stabilizing and improving by 3 to 4 days of life, discussion with parents about the reality that the infant is likely not a pulmonary survivor is necessary." (clinical) [Ep 3 · 27:04](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1624)
- "The question of pulmonary survival may need to be revisited later, most frequently in the setting of sepsis, where infants on peritoneal dialysis who develop infection can progress from room air to ventilator dependence and never be weaned." (clinical) [Ep 3 · 27:39](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1659)
- "When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels." — Jan Scober (clinical) [Ep 3 · 28:58](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1738)
- "Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries." — Jan Scober (clinical) [Ep 3 · 29:16](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1756)
- "Temporary hemodialysis catheters in newborns are difficult to maintain because there is limited catheter design for small children, resulting in excess extravascular catheter length that moves despite securing attempts." (clinical) [Ep 3 · 30:22](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1822)
- "Hemodialysis catheters in newborns are 8 French in size and are limited to jugular vein placement; even tunneled catheters are likely to cause local thrombosis or central circulation stenosis." (clinical) [Ep 3 · 30:44](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1844)
- "Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated." — Jan Scober (clinical) [Ep 3 · 31:28](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1888)
- "High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients." — Jan Scober (clinical) [Ep 3 · 31:43](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1903)
- "Formula density for infants with CKD is inversely related to urine output volume." — Jan Scober (clinical) [Ep 3 · 32:06](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1926)
- "Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis." — Jan Scober (clinical) [Ep 3 · 32:18](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1938)
- "It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition." — Jan Scober (clinical) [Ep 3 · 32:45](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1965)
- "Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk." — Jan Scober (clinical) [Ep 3 · 33:03](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=1983)
- "The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration." — Jan Scober (clinical) [Ep 3 · 33:39](https://library.globalcastmd.com/watch/fetal-management-of-advanced-chronic-kidney-disease-fetal-genitourinary-916?t=2019)
- "Fetuses with bladder outlet obstruction and oligohydramnios present with posterior placentas, hands and feet up in front of the face, compressed chest, difficult-to-visualize stomach, and bladder visible at the base with umbilical cord and hypogastric arteries bifurcating around it." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Amnioinfusion is needed if the patient is a candidate for shunt placement and is performed as the first step in evaluation at Cincinnati Fetal Center." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Karyotype can usually be obtained from a washing of the amniotic sac during amnioinfusion." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Amnioinfusion allows visualization of the uncompressed chest for size measurement and comparison to norms, which helps predict pulmonary hypoplasia." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Heart size ratios are very critical in prognosis for fetuses with bladder outlet obstruction." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Associated cardiac anomalies are not common in fetal genitourinary disease." — Bill (epidemiological) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Posturing of hands and feet can be part of the diagnosis when looking for complex genetic syndromes." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Velamentous cord insertions could complicate shunt placement." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "After intervention, if fluid volume drops off again due to end-stage fetal renal disease, repeat amnioinfusions can be performed through several different techniques." — Bill (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- "Profound oligohydramnios makes diagnosis difficult in bladder outlet obstruction cases." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Fairly dilated and tortuous ureters can be confused with a big bladder by referring physicians." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Bladder outlet obstruction diagnosis has shifted from mid-trimester to early third trimester detection in the past to now being diagnosed just outside of the first trimester." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "A keyhole configuration of the bladder is commonly seen with posterior urethral valves or other obstructive neuropathies." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "When assessing kidneys for renal function prediction, echogenicity of the parenchyma and orientation of renal cysts should be evaluated." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Tortuous structures extending below the lower pole of the kidney are more likely dilated ureters than dilated kidneys." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Irregular configuration, inconsistent echogenicity, and wide distribution of cyst size are concerning findings in renal imaging." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Early in the disease process, renal cysts can be distributed around the outer pole of the kidney, then become more disoriented and distorted as the process progresses." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "It is important to confirm the presence of two kidneys, as multicystic dysplastic kidney can be associated with absence of the contralateral kidney." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "Bladder outlet obstruction is not just isolated to the genitourinary system; evaluation must include looking for a variety of other abnormalities." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "With oligohydramnios, the problem comes back to pulmonary hypoplasia, and if pulmonary hypoplasia is in place, it is very difficult to correct." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "A bell-shaped thorax with lower ribs being pushed out indicates the pulmonary circuit is not developing normally." — Jaco (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- "If kidneys are high enough or big enough to impair diaphragmatic excursion, there is a bigger problem and more likely diagnosis of pulmonary hypoplasia." — Jaco (clinical) [Ep 2 · 8:54](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=534)
- "Loss of diaphragmatic movement from phrenic nerve dissection is a primary reason for pulmonary hypoplasia, and big kidneys can cause the diaphragm to stop moving and create the same crisis for pulmonary development." — Jaco (clinical) [Ep 2 · 8:54](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=534)
- "MRI provides a visual image that parents can better understand and gives a big picture of the baby with clear images for parents to see when dealing with a renal abnormality." — Jaco (opinion) [Ep 2 · 9:43](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=583)
- "For bladder outlet obstruction, ultrasound alone is not sufficient; MRI is a very important discriminator for comprehensive evaluation." — Jaco (opinion) [Ep 2 · 9:43](https://library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=583)

## Changelog
- Sep 15: 3 items added automatically

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