Normal Urinary Tract Research Articles

Urethral obstruction of 6 hours or less causes bacteriuria, bacteremia, and pyelonephritis in mice challenged with "nonuropathogenic" Escherichia coli.

Urethral obstruction may be caused by prostatic hypertrophy, urethral stricture, or encrustation of a urethral-catheter lumen. Bacteriuria often complicates these obstructions. The sequelae include fever, acute pyelonephritis, chronic renal inflammation, and death. We hypothesized that even brief obstruction of the urinary tract containing a nonvirulent bacterium would result in these complications. Mice challenged transurethrally with Escherichia coli FN414, which is rapidly eliminated from normal mice without causing bacteriuria, bacteremia, or renal pathology, were subjected to reversible urethral obstruction by coating the urethral meatus with collodion for 1, 3, or 6 h. The majority of mice obstructed for 1 h demonstrated parenchymal renal inflammation 48 h later. At the end of 3 h of obstruction, 9 of 10 mice were bacteremic; some bacteremias were present at 48 h after removal of the obstruction. At that time, more severe renal inflammation was seen in these mice. As little as 6 h of obstruction resulted not only in the acute changes described above but also in chronic renal inflammation and fibrosis in the majority of animals sacrificed 3 and 6 weeks later. Additional studies demonstrated that urethral obstruction enhanced the uropathogenicity of another nonpathogenic E. coli strain (K-12 strain HB101) and caused more severe renal lesions in mice challenged with E. coli CFT073, isolated from a patient with symptoms of pyelonephritis. These findings demonstrate that brief urethral obstruction may (i) induce organisms which are cleared rapidly from the normal urinary tract to cause bacteriuria, bacteremia, and pyelonephritis and (ii) intensify the renal lesions caused by a uropathogen.

Proliferative activity of urothelial neoplasms: comparison of BrdU incorporation, Ki67 expression, and nucleolar organiser regions.

To evaluate the proliferative activity of urothelial neoplasms, compare it with that of the normal urinary tract epithelium, and determine its relation to morphological grade and presence of invasion. Multiple biopsy specimens from 53 individuals--eight normal controls, five patients with severe urothelial atypia, and 40 with transitional cell carcinomas (TCCs)--were studied using in vitro bromodeoxyuridine (BrdU) incorporation, Ki67 antigen expression, and quantitation of the nucleolar organiser regions (NORs). The percentage of nuclei labelled by BrdU (BrdU index) correlated well with the percentage of nuclei expressing the Ki67 antigen (Ki67 index). These proliferation indices were very low (less than 0.1% in 60% of samples) in the urothelium of normal controls and the morphologically unremarkable epithelium of patients with TCCs. Non-invasive TCCs had increased proliferation (BrdU index 6.32 (SD 0.8)%, Ki67 index 5.04 (0.6)% but lagged behind the invasive tumours (BrdU 20.9 (3.2)%, Ki67 18.6 (2.8)%). The average NOR count was 1.57 (0.03) in morphological normal epithelium, which increased progressively with grade in non-invasive TCCs, but varied greatly in invasive tumours and did not correlate with the proliferation indices. The spectrum of values for both proliferation indices and NORs was particularly wide in grade 2 TCCs. Severe atypias without exophytic growth had an increase in BrdU and Ki67 indices comparable with that found in grade 3-4 invasive TCCs; these also had the highest NORs per nucleus. The growth potential of urothelial neoplasms is an important indicator of their aggressive course. In particular, growth indices over 10% are strongly associated with the presence of invasion. Papillary grade 2 TCCs show heterogeneity in their growth characteristics which may relate to their diverse clinical course. The mitotic count underestimates the growth potential of papillary TCCs and the addition of proliferation indices such as BrdU incorporation or the Ki67 index may enhance the prognostic accuracy of conventional morphological grading.

Management of lower urinary tract infections.

Most urinary tract infections (UTIs) present as bacterial cystitis in healthy women in the sexually active age group. The commonest pathogen is Escherichia coli and most of the remainder are due to Staphylococcus saprophyticus. Many women are prone to recurrent UTIs and these are invariably due to a reinfection with a different organism. After diagnosis, a curative course of treatment should be given, but the approach should be different if the infection is uncomplicated (normal urinary tract and normal renal function) as opposed to complicated (male patient, abnormal urinary tract, impaired host defence mechanisms, impaired renal function, infection with a virulent organism). It is believed that traditional dosage regimens for uncomplicated UTIs are extravagant. There is no convincing evidence that a long course of medication is more effective than a short one; in fact, the use of single dose therapy for uncomplicated UTIs is gaining support. Trimethoprim 600mg, cotrimoxazole (trimethoprim/sulfamethoxazole) 1.92g, fosfomycin trometamol 3g and the 4-quinolones are the preferred agents for single dose treatment. Failure of single dose therapy is a simple guide for the need for further urinary tract investigation or more intensive therapy. If UTIs recur, it may be necessary to consider long term, low dose prophylaxis. The most effective drugs for this type of treatment include nitrofurantoin 50mg, trimethoprim 100mg and norfloxacin 200mg, given at night. More recent studies show that a dose administered on alternate nights, 3 nights a week or after intercourse is just as effective.

Neuropathic urinary incontinence in pediatric patients: Management with artificial sphincter

From June 1982 to November 1990, 37 patients, aged 13 to 19 years (35 males and 2 females), were treated in our division for neuropathic urinary incontinence with an artificial sphincter. All patients were treated before sphincter implantation with drugs, transurethral sphincterotomy in boys, and bladder flap urethroplasty was carried out in females during the surgical procedure. The cuff was placed at the bladder neck in 33 cases, and in 4 cases at the urethral bulb. The sphincter was activated about 3 weeks after implantation and after 2 months in two patients with associated bladder augmentation. Operative and perioperative complications occurred in four cases during the initial phase of our experience. Later we had to perform 19 revisions on 14 patients due to mechanical and surgical failure (reoperation rate, 0.38). Thirty-three patients are presently dry (90% of successes). Postoperatively, normal upper urinary tract conditions were found in all patients except two.

Outcome of Pregnancy in an Oxford-Cardiff Cohort of Women with Previous Bacteriuria

To investigate the influence of asymptomatic bacteriuria in childhood on subsequent pregnancy, we reviewed the outcome of 139 pregnancies in 88 women who were first identified during a programme of screening schoolgirls for asymptomatic bacteriuria carried out between 1970-1972. Data were analysed for the following groups: 50 pregnancies in 28 women with known renal scars (group 1); 16 pregnancies in 14 women with normal kidneys and reflux (group 2); 73 pregnancies in 46 women with normal urinary tracts (group 3); 139 healthy controls. Women in group 1 had a 3.3-fold increased relative risk of hypertension (p < 0.01) and a 7.6-fold increased risk of pre-eclampsia (p < 0.05) compared to controls, and a higher rate of obstetric interventions, including emergency caesarean section. Women in groups 2 and 3 appeared to carry a slightly increased risk of hypertension during the last trimester (RR = 1.8) but there were no significant differences in this or the incidence of pre-eclampsia or mode of delivery. Bacteriuria was more prevalent in all index groups compared to controls (37 per cent vs. 8 per cent, p < 0.01) and included four cases of acute pyelonephritis in in the study group. Fetal outcome was satisfactory in all cases. These results suggest that women with renal scars are at risk of hypertension and pre-eclampsia during pregnancy but that modern obstetric care minimizes these risks.

Study on local immune response in Escherichia coli-induced experimental urinary tract infection in mice--infiltration of Ia-positive cells, macrophages, neutrophils, T cells and B cells

We studied the local immune response in a mouse experiment with acute ascending cystitis and pyelonephritis. The experimental infections were induced in BALB/c female mice by transurethral instillation of Escherichia coli O6. Immune response cells were stained, including Ia-positive cells, macrophages, neutrophils, T cells (CD4+ and CD8+) and B cells (IgA, IgM, IgG-positive B cell). They were stained by the immunohistochemical method (ABC method) using monoclonal antibodies against lineage specific antigens except for neutrophils that were readily identified by the standard hematoxylin-eosin. Even in the control mice having no evidence of the infection, mucosa associated lymphoid tissue (MALT) consisted of macrophages, Ia-positive cells and T cells that were sparingly found in the urinary tract tissue and renal parenchyma. Ia-positive cells, macrophages, neutrophils, T cells (CD4+, CD8+) and IgA positive B cells were significantly infiltrated in the bladder submucosa from 6 hours after bacterial inoculation. The infiltration of similar immune response cells was found in the submucosa of the renal pelvis, except for IgA positive B cells that appeared one day after the induction of the infection. In renal parenchyma, Ia-positive cells appeared at 6 hours after introduction of the infection, followed by an infiltration of neutrophils, macrophages and T cells (CD4+, CD8+) at the first day, and IgA positive B cells at the third day. These results are summarized as follows. When microbes invaded the urinary tract tissue, a significant number of Ia-positive cells infiltrated, which were initially present in normal urinary tract tissue. Subsequently, neutrophils, macrophages and T cells (CD4+, CD8+) appeared in the lesion followed by a delayed occurrence of IgA positive B cells.

The Natural History of Urinary Infection in Adults

The vast majority of otherwise healthy adults with anatomically and functionally normal urinary tracts experience few untoward long-term consequences from symptomatic or asymptomatic UTIs. Effective early treatment of symptomatic infection rapidly curtails bacterial invasion and the resulting inflammatory response. Rarely, uncomplicated acute pyelonephritis causes suppuration and renal scarring. Urinary infections in patients with renal calculi, obstructed urinary tract, neurogenic bladder, or diabetes are frequently much more destructive and have ongoing sequelae. Strategies to treat both the infection and the complications are often necessary to alter this outcome.

Sigmoid Colon Conduit Urinary Diversion in a Renal Transplant Recipient

Renal allotransplantation is the treatment of choice for patients with end-stage renal disease (ESRD). With increasing technical expertise, it has been realised that presence of a normal lower urinary tract is not a necessity for transplantation. Advanced genito-urinary tuberculosis frequently leads to a small-capacity bladder. Herein, we present a case of ESRD due to urinary tuberculosis in whom sigmoid colon conduit urinary diversion was carried out. The immunosuppressed status did not increase the complications of a sigmoid colon conduit urinary diversion.

First and early second‐trimester diagnosis of fetal urinary tract anomalies using transvaginal sonography

Urinary tract anomalies are common. Prenatal diagnosis is important and enables either special obstetric management or termination of pregnancy and probably in the future, intrauterine intervention. Transvaginal sonography (TVS) allows visualization of the normal and anomalous fetal urinary tract at an early stage. One thousand nine hundred and forty women were examined via TVS at an early stage of pregnancy between 10 and 16 weeks from the last menstrual period (LMP) and 35 anomalies (1.8 per cent) were clearly identified: 29 cases of low urinary tract obstruction, 2 cases of multicystic dysplastic kidney, 2 cases of polycystic kidney (infantile type), 1 case of double collecting system, and 1 case of horseshoe kidney. Potter syndrome could be ruled out in three patients who had delivered fetuses suffering from this anomaly in previous pregnancies. The concise and early identification of anomalies makes TVS an important aid in the hands of the obstetrician, ultrasonographer, and neonatologist.

Value of antenatal diagnosis of abnormalities of the urinary tract

OBJECTIVE--To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN--Retrospective study. SETTING--Two obstetric units in Glasgow. SUBJECTS--62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS--Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT--Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS--Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS--The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.

Upper Urinary Tract Deterioration after Implantation of Artificial Urinary Sphincter

The preoperative urodynamic evaluations of twenty patients with myelomeningocele who had had artificial sphincter implantation because of urinary incontinence were reviewed. Four patients developed hydronephrosis and severe impairment of renal function between two and six years after implantation of the artificial sphincter. The condition was partly reversible after removal of the artificial sphincter. The urodynamic evaluation prior to implantation revealed in the four mentioned patients compared to the 16 patients with normal upper urinary tract, a tendency to lower bladder compliance, lower bladder capacity and more severe detrusor hyperreflexia, but it was not possible to make a clear discrimination between the two groups. Attention is drawn to this unfortunate combination of effects after artificial sphincter implantation. Periodic control of the upper urinary tract by urography is recommended.

Long‐Term Effectiveness Of The Burch Colposuspension In Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow-up examinations 5 years after surgery for evaluation of late complications and long-term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71% of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non-significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow-up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow-up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long-term problem after colposuspension. At the 5-year follow-up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.

Urodynamic Investigation of the Ileal Conduit: Upper Tract Dilatation and the Effects of Revision of the Conduit

Urodynamic studies of the ileal conduit were performed in 36 patients with normal upper urinary tracts (controls) and in 32 who had progressive upper tract dilatation within 6 years preceding the study. In controls the conduit emptied mainly by means of low pressure, to-and-fro activity. In contrast, high frequency, high amplitude peristaltic activity was found commonly in patients with upper tract dilatation, such activity being consistent with obstruction of the distal conduit. Of the 32 patients with upper tract dilatation 17 underwent reoperation on the conduit as well as postoperative urodynamic studies. Among these 17 patients a decrease was observed in basal pressure in the conduit postoperatively compared to preoperatively (5 ± 4 and 12 ± 6cm. water, p less than 0.001). A decrease also was found postoperatively in the frequency (4 ± 6 and 36 ± 28 per hour, p less than 0.001) and amplitude (34 ± 47 and 61 ± 28cm. water, p less than 0.001) of peristaltic activity. Radiological improvement in the appearance of the upper urinary tracts was found in 9 patients (53 per cent) postoperatively.These findings support the hypothesis that upper tract dilatation in certain patients with an ileal conduit may be caused by high pressure activity in the presence of free ureteral reflux. Such abnormalities, which are probably the result of obstruction of the distal conduit, may be detected by means of urodynamic evaluation and may be corrected by revision of the conduit.

Value of antenatal diagnosis of abnormalities of the urinary tract.

To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. Retrospective study. Two obstetric units in Glasgow. 62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.

Antenatal Diagnosis of Congenital Abnormalities in the Urinary Tract: Results From the Northern Region Fetal Abnormality Survey

Summary— One hundred and sixty-two cases of suspected congenital abnormalities of the urinary tract notified to the Northern Region Fetal Abnormality Survey Register between the beginning of 1984 and the end of 1986 were studied. These cases represented 14.3% of total notifications, which in turn were 0.93% of total births. There were a further 25 cases notified but not due for delivery until early 1987; 10 of these were urological. Thirty-five cases (22%) notified proved postnatally to have normal urinary tracts and 21 (13.2%) had unsuspected urinary tract abnormalities. Of the 106 cases in which a suspected urinary tract abnormality was confirmed postnatally, confirmation was obtained at perinatal death in 32 and by ultrasound, radiographic and radioisotope investigation in the remainder; 34.5% of all urological cases registered and 75% of the confirmed survivors were treated surgically. The urological abnormality most frequently missed was posterior urethral valves. Attempts to diagnose the fetal sex were seldom made but when they were the prediction was usually male and usually correct. The perinatal mortality in this group was 0.43/1000 births, a contribution of nearly 4% to overall perinatal mortality in the Northern Region.

Pyeloureteral dynamics. Pelvic pressure and kidney function in partial long-term ureteric obstruction.

In 10 pigs with reno-scintigraphically proven normal upper urinary tracts, a standardized partial obstruction of the left ureter was created at the lower kidney pole level. Three weeks later kidney function was scintigraphically reassessed and the pressure flow relationship in the flow range 0-20 ml/min outlined. The partially obstructed pelvic baseline pressure varied from 9.0 to 32.0 cmH2O. During perfusion small increases in pelvic pressure were seen at all flow rates in the individual cases and there was a linear relationship between pressure and flow. Compared to previous results of a similar but acute obstruction the results were identical in pressure ranges and pressure flow profile. This demonstrates, that a longitudinal stability in transport mechanism qualities is present also during the course of obstruction. The pelvic pressure at low flow rates was significantly correlated to kidney function depression, whereas perfusion pressures at high flow rates did not show any correlation, except at 20 ml/min. This clearly indicates, that the pelvic pressure at normal urine flow rate is an important factor in the pathogenesis of obstructive nephropathy.

Follow-Up of Infants With Bilateral Renal Disease Detected In Utero. Growth and Renal Function

• We studied 69 infants who had urinary tract abnormalities detected by antenatal ultrasound examination. There were 21 intrauterine or immediate neonatal deaths; in all 21 infants, severe bilateral renal disease incompatible with life was found at autopsy. Six of the liveborn infants with abnormal results of antenatal ultrasound examinations had a normal urinary tract after birth. Of the remaining 42 infants, the prenatal diagnosis was confirmed with renal ultrasound and other studies during the first week of life. Twenty-one of 42 infants had bilateral renal disease. We obtained follow-up data on 19 of 21 of these infants. Twelve of 19 had obstructive uropathy that was treated surgically. After one to 51 (mean, 18) months of follow-up, renal function varied. Ten of 19 patients had a calculated glomerular filtration rate greater than or equal to 79 mL/min/1.73 m 2 . One infant required long-term ambulatory peritoneal dialysis. Renal function (glomerular filtration rate, 74±5 mL/min/1.73 m 2 ) and growth (height percentile, 41±8) were unexpectedly good considering the severity of the urinary tract abnormalities. Prenatal detection of bilateral renal disease followed by careful medical and surgical management results in a favorable outcome with good growth and renal function. ( AJDC 1988;142:453-456)

Antenatal diagnosis of congenital abnormalities in the urinary tract. Results from the Northern Region Fetal Abnormality Survey.

One hundred and sixty-two cases of suspected congenital abnormalities of the urinary tract notified to the Northern Region Fetal Abnormality Survey Register between the beginning of 1984 and the end of 1986 were studied. These cases represented 14.3% of total notifications, which in turn were 0.93% of total births. There were a further 25 cases notified but not due for delivery until early 1987; 10 of these were urological. Thirty-five cases (22%) notified proved postnatally to have normal urinary tracts and 21 (13.2%) had unsuspected urinary tract abnormalities. Of the 106 cases in which a suspected urinary tract abnormality was confirmed postnatally, confirmation was obtained at perinatal death in 32 and by ultrasound, radiographic and radioisotope investigation in the remainder; 34.5% of all urological cases registered and 75% of the confirmed survivors were treated surgically. The urological abnormality most frequently missed was posterior urethral valves. Attempts to diagnose the fetal sex were seldom made but when they were the prediction was usually male and usually correct. The perinatal mortality in this group was 0.43/1000 births, a contribution of nearly 4% to overall perinatal mortality in the Northern Region.

Cholestatic jaundice with urinary tract infection in a child with acute lymphoblastic leukaemia

The syndrome of cholestatic jaundice in association with urinary tract infection with normal or slightly elevated liver enzymes has been reported mainly in newborns and infants below 2 months of age. The relative immaturity of the infant's liver and its sensitivity to bacterial endotoxins may explain the occurrence of this syndrome in this age group. A similar syndrome has been reported in adults with severe non-hepatic bacterial infection, including some with urinary tract infection. However, only three case reports in older children could be found. In this report, the case of a 4-year-old girl with acute lymphoblastic leukaemia, who presented with cholestatic jaundice with normal liver enzymes and urinary tract infection, is described. Treatment with antibiotics resulted in resolution of the jaundice and potentially hepatotoxic drugs were used for the treatment of leukaemia with no problems. Two adult patients with acute leukaemia, non-hepatic bacterial infection and cholestatic jaundice have been reported; both died shortly after diagnosis.

Follow-up of infants with bilateral renal disease detected in utero. Growth and renal function.

We studied 69 infants who had urinary tract abnormalities detected by antenatal ultrasound examination. There were 21 intrauterine or immediate neonatal deaths; in all 21 infants, severe bilateral renal disease incompatible with life was found at autopsy. Six of the live-born infants with abnormal results of antenatal ultrasound examinations had a normal urinary tract after birth. Of the remaining 42 infants, the prenatal diagnosis was confirmed with renal ultrasound and other studies during the first week of life. Twenty-one of 42 infants had bilateral renal disease. We obtained follow-up data on 19 of 21 of these infants. Twelve of 19 had obstructive uropathy that was treated surgically. After one to 51 (mean, 18) months of follow-up, renal function varied. Ten of 19 patients had a calculated glomerular filtration rate greater than or equal to 79 mL/min/1.73 m2. One infant required long-term ambulatory peritoneal dialysis. Renal function (glomerular filtration rate, 74 +/- 5 mL/min/1.73 m2) and growth (height percentile, 41 +/- 8) were unexpectedly good considering the severity of the urinary tract abnormalities. Prenatal detection of bilateral renal disease followed by careful medical and surgical management results in a favorable outcome with good growth and renal function.