THE CURRENT APPROACH TO THE ASSESSMENT OF FETAL RENAL-FUNCTION - FACTOR FICTION

The wide use of ultrasonography during pregnancy has led to the identi fication of a relatively large number of renal and urinary tract abnor malities, particularly hydronephrosis. Uncertainty, however, exists re garding the indications for surgical intervention. Prominent among the variables currently used to assess fetal renal function and predict t he long-term outcome are measurements of urinary concentration of elec trolytes and low molecular weight proteins. It has become, therefore, imperative to examine the evidence on which the selection of these var iables is based, before they become entrenched in medical practice. Th e analysis reveals that single measurements of any of these variables is unlikely to be reliable. Sequential measurements, albeit more depen dable, are impractical due to the narrow window of opportunity for use ful surgical intervention. It is therefore necessary to search for new , innovative approaches aimed at detecting changes in the kidney or ur ine that reflect the biological response of the developing kidney to i njury. Such markers may be represented by renal metabolites or peptide s involved in the maintenance of renal function under conditions of st ress.