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Chapter 14.2 - Fetal urinary tract obstruction

Prenatal assessment and prognosis

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Nahla Khalek  and
Mark P. Johnson
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson
Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes
Affiliation:
Department of Obstetrics, Leiden University Medical Center
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Summary

Introduction

The natural history of congenital lower urinary tract obstruction (LUTO) is highly variable and dependent on the gender, severity, duration, and age of onset of the obstruction. Complete obstruction of the urethra early in gestation can lead to massive distention of the bladder, hydroureteronephrosis, and renal fibrocystic dysplasia. Inability of the urine to enter the amniotic space results in oligohydramnios, leading to pulmonary hypoplasia and secondary deformations of the face and extremities. Outcome is measured in terms of postnatal survival and is dependent on two factors: pulmonary development and renal function. Of these, pulmonary development may be the most critical for neonatal survival.

Experimental studies for evaluating fetal renal function

Prenatal clinical determination of renal injury in obstructive uropathy has been problematic [1–4]. Several studies have assessed the predictive value of the ultrasonographic appearance of the fetal kidneys as an indicator of damage. However, such observational impressions lack the sensitivity/specificity for accurate correlation with renal function [5–7]. As renal function deteriorates, urine production diminishes and is reflected by a decline in amniotic fluid volume. However, quantitative assessment of amniotic fluid volume alone is a poor measure of renal function, because renal dysplasia may already be irreversibly established by the time oligohydramnios is ultrasonographically detected [2, 8].

Keywords

urinary tract obstructionpulmonary developmentrenal functionsmooth muscle hypertrophyprenatal therapyfetal urinefetal bladder
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 246 - 252
Publisher: Cambridge University Press
Print publication year: 2012

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