Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Section 1 General principles
- Section 2 Fetal disease
- Chapter 6 Red cell alloimmunization
- Chapter 7 Fetal and neonatal alloimmune thrombocytopenia
- Chapter 8.1 Fetal dysrhythmias
- Chapter 8.2 Fetal dysrhythmias
- Chapter 9.1 Structural heart disease
- Chapter 9.2 Structural heart disease
- Chapter 9.3 Structural heart disease
- Chapter 10.1 Manipulation of amniotic fluid volume
- Chapter 10.2 Manipulation of amniotic fluid volume
- Chapter 11.1 Twin-to-twin transfusion syndrome
- Chapter 11.2 Twin-to-twin transfusion syndrome
- Chapter 11.3 Twin-to-twin transfusion syndrome
- Chapter 11.4 Twin-to-twin transfusion syndrome
- Chapter 11.5 Twin-to-twin transfusion syndrome
- Chapter 12.1 Twin reversed arterial perfusion (TRAP) sequence
- Chapter 12.2 Twin reversed arterial perfusion (TRAP) sequence
- Chapter 13.1 Fetal infections
- Chapter 13.2 Fetal infections
- Chapter 14.1 Fetal urinary tract obstruction
- Chapter 14.2 Fetal urinary tract obstruction
- Chapter 14.3 Fetal urinary tract obstruction
- Chapter 14.4 Fetal urinary tract obstruction
- 15.1 Fetal lung growth, development, and lung fluid
- Chapter 15.2 Fetal lung growth, development, and lung fluid
- Chapter 16.1 Neural tube defects
- Chapter 16.2 Neural tube defects
- Chapter 17.1 Fetal tumors
- Chapter 17.2 Fetal tumors
- Chapter 18.1 Intrauterine growth restriction
- Chapter 18.2 Intrauterine growth restriction
- Chapter 19.1 Congenital diaphragmatic hernia
- Chapter 19.2 Congenital diaphragmatic hernia
- Chapter 20.1 Fetal stem cell transplantation
- Chapter 20.2 Fetal stem cell transplantation
- Chapter 20.3 Fetal stem cell transplantation
- Chapter 21 Gene therapy
- Chapter 22 The future
- Glossary
- Index
- References
Chapter 14.1 - Fetal urinary tract obstruction
Pathophysiology
from Section 2 - Fetal disease
Published online by Cambridge University Press: 05 February 2013
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Section 1 General principles
- Section 2 Fetal disease
- Chapter 6 Red cell alloimmunization
- Chapter 7 Fetal and neonatal alloimmune thrombocytopenia
- Chapter 8.1 Fetal dysrhythmias
- Chapter 8.2 Fetal dysrhythmias
- Chapter 9.1 Structural heart disease
- Chapter 9.2 Structural heart disease
- Chapter 9.3 Structural heart disease
- Chapter 10.1 Manipulation of amniotic fluid volume
- Chapter 10.2 Manipulation of amniotic fluid volume
- Chapter 11.1 Twin-to-twin transfusion syndrome
- Chapter 11.2 Twin-to-twin transfusion syndrome
- Chapter 11.3 Twin-to-twin transfusion syndrome
- Chapter 11.4 Twin-to-twin transfusion syndrome
- Chapter 11.5 Twin-to-twin transfusion syndrome
- Chapter 12.1 Twin reversed arterial perfusion (TRAP) sequence
- Chapter 12.2 Twin reversed arterial perfusion (TRAP) sequence
- Chapter 13.1 Fetal infections
- Chapter 13.2 Fetal infections
- Chapter 14.1 Fetal urinary tract obstruction
- Chapter 14.2 Fetal urinary tract obstruction
- Chapter 14.3 Fetal urinary tract obstruction
- Chapter 14.4 Fetal urinary tract obstruction
- 15.1 Fetal lung growth, development, and lung fluid
- Chapter 15.2 Fetal lung growth, development, and lung fluid
- Chapter 16.1 Neural tube defects
- Chapter 16.2 Neural tube defects
- Chapter 17.1 Fetal tumors
- Chapter 17.2 Fetal tumors
- Chapter 18.1 Intrauterine growth restriction
- Chapter 18.2 Intrauterine growth restriction
- Chapter 19.1 Congenital diaphragmatic hernia
- Chapter 19.2 Congenital diaphragmatic hernia
- Chapter 20.1 Fetal stem cell transplantation
- Chapter 20.2 Fetal stem cell transplantation
- Chapter 20.3 Fetal stem cell transplantation
- Chapter 21 Gene therapy
- Chapter 22 The future
- Glossary
- Index
- References
Summary
Introduction
Fetal urinary tract obstruction accounts for the largest identifiable cause of kidney failure in infants and children. As for other congenital malformations, the etiology of most cases of congenital obstructive nephropathy is unknown. The site of obstruction along the urinary tract varies from the ureteropelvic junction (UPJ), to the ureterovesical junction and urethra. The hallmark of obstructive nephropathy is hydronephrosis with calyceal dilatation and renal parenchymal thinning depending on the location, timing, and severity of obstruction.
The human metanephros forms by the 5th week of gestation, and nephrogenesis continues through the 34th week, with ongoing perinatal and postnatal maturation through the first two years of life. Congenital obstructive lesions may be associated with abnormal renal development, resulting in renal agenesis, hypoplasia, or dysplasia. There are now substantial experimental data to support a direct effect of urinary tract obstruction on renal growth and development. The molecular basis of these effects has been investigated, suggesting a role for central regulators of epithelial differentiation, such as Wilms tumor-1 (WT1) and paired box gene 2 (PAX2), regulators of stromal development and extracellular matrix formation, as well as mediators of cell growth and survival, such as angiotensin, transforming growth factor-β (TGFβ), and B-cell lymphoma-2 (Bcl-2) [1].
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- Fetal TherapyScientific Basis and Critical Appraisal of Clinical Benefits, pp. 238 - 245Publisher: Cambridge University PressPrint publication year: 2012