MANAGEMENT OF PRENATALLY DETECTED FETAL HYDRONEPHROSIS

The increased frequency of prenatal ultrasonography has resulted in an increase in the detection of fetal genitourinary abnormalities, many of which are of minimal clinical significance. Severe fetal urinary tr act obstruction with associated oligohydramnios results in a recogniza ble constellation of physical findings, including renal dysplasia, pul monary hypoplasia, and perinatal death. In selected cases, prenatal in tervention to decompress urinary tract obstruction may reestablish amn iotic fluid volume, prevent renal damage, and allow normal pulmonary d evelopment. After severe renal injury has occurred, intervention is un likely to improve the prognosis of the affected fetus, Renal function may be analyzed prenatally by ultrasound examination and determination of chemical composition of fetal urine in order to identify fetuses i n whom kidney development has not yet been irrevocably damaged and tho se likely to benefit from prenatal intervention. Postnatal renal evalu ation with ultrasonography, voiding cystourethrography, and radionucli de imaging facilitates further characterization of the abnormality det ected on prenatal ultrasound examination.