EXPERIENCES IN THE MANAGEMENT OF INFANTS WITH ANTENATAL DIAGNOSED URINARY-TRACT MALFORMATIONS

Between 1984 and 1991, antenatal ultrasound scanning detected urinary tract malformations in 126 infants, who were investigated and treated postnatally in the childrens' hospital of the Westfalische Wilhelms-Un iversity Munster. 10 out of 126 children with urogenital changes, died in the first hours after birth, due to pulmonary hypoplasia (Potter's sequence), 1 further infant died later after cardiac operation, and a nother died of megacystic-megaureter-hypoperistaltic-syndrome. In the first months after birth 71 (61 %) of 116 infants underwent urological surgery; 12/116 infants (10.3%) had severe bilateral kidney changes, some of them with severe deficiency of amniotic fluid before birth. 6/ 116 infants (5.2%) had chronic renal insufficiency, 2 of them will hav e to be dialyzed in early childhood and longterm, 14 patients (12%) ar e threatened by chronic renal failure. 14 patients (12%) developed sev ere arterial hypertension, all had to be treated with antihypertensive drugs, in 5 of them hypertension subsided after unilateral nephrectom y, another five had transient hypertension, but four require continued medical treatment. We describe the prenatal ultrasound findings, comp are them with diagnosis after birth, illustrate diagnostics, plans of therapy, urological surgical interventions and nephrological consequen ces. Benefits and limitations of antenatal ultrasonography for the det ection of urinary tract malformations and the treatment of those malfo rmations before and after birth are discussed. In utero diagnosis of s evere urinary tract abnormalities allows treatment of these infants im ediatly after birth, furthermore the prevention of severe infections, additional damage of renal tissue, and early diagnosis and treatment o f arterial hypertension and metabolic imbalances caused by chronic ren al insufficiency in early childhood.