Diagnostik angeborener Harntransportstörungen

Abstract

Congenital anomalies of the kidneys and urinary tract are prenatally diagnosed by ultrasound as early as in the 16th week of gestation. In some specialized centres, ultrasound screening can be followed-up by fetal magnetic resonance imaging (MRI). The careful interpretation of results and scheduling of antenatal and postnatal control examinations are of great importance. Multidisciplinary perinatal counseling should be offered to the parents. If complex anomalies have been diagnosed, delivery in a specialized center should be recommended where neonatologists, pediatric nephrologists, pediatric radiologists and pediatric surgeons/urologists can take care of the newborn.All diagnostic and therapeutic measures aim at avoiding progressive loss of renal function, initially with conservative treatment. Immediate surgical interventions are required in rare cases, depending on the localization and degree of urinary obstruction. Unilateral anomalies (e.g. dilation of renal pelvis and/or ureter) are generally followed-up by ultrasound controls and split renal function studies. Surgical interventions are needed if there is a considerable risk of deterioration of renal function; however, bilateral anomalies and posterior urethral valves often require a different approach with rapid intervention. If renal function is already impaired all treatment options aim at reducing the progression of chronic renal insufficiency. Renal replacement therapy is generally possible and available in specialized centers even in the neonatal period.