Diagnosis and Treatment of Renal and Urinary Tract Malformations

Perinatal renal and ureteral tract diseases are the main cause of end-stage renal failure in children. Most urogenital abnormalities are diagnosed antenatally on high-resolution ultrasound scan, preparing for postnatal care. The most types of malformations, such as primary vesicoureteral reflux and congenital pelviureteric junction obstruction, are relatively common. They may be characterized both prenatally, in most severe forms, and portnatally. Another condition that do not poses prenatal diagnostic problems and which is normally most severe but rare than the previous conditions is the posterior urethral valves. However, multicystic dysplastic kidney is easily prenatally recognized and postnatally managed. Normally, polycystic kidney disease normally not poses prenatal diagnostic problem. Anymore, the goal of intervention of renal and urinary tract malformations is to preserve renal function when urinary tract dilatation is the consequence of obstruction. The overall major difficulties remain the prenatal approaches of severe renal and urinary tract malformations, the postnatal therapeutic interventions and the supportive measures. Fetal intervention should be considered in those cases where severe oligohydramnios is associated with hydronephrosis, especially in the presence of solitary kidney or in bilateral disease. Overall, there are problems of ethical reason that one may encounter after the prenatal diagnosis of bilateral renal agenesis or bilateral renal dysplasia, and other severe renal conditions leading to renal failure. With the advances in dialysis and transplantation for young children, it is now possible to prevent the early death of at least some individuals with severe malformations.