Birth Defects In Kidneys & Urinary Tract

Birth Defects In Kidneys & Urinary Tract

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    When an abnormality occurs in the development of the kidneys or urinary tract and only one kidney is affected, the other kidney is usually capable of increasing in size and function to compensate for the abnormal kidney. Children with only one normal kidney still have enough kidney function to grow and develop normally. 
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    Before birth, the mother's placenta performs most of the functions of the kidney. As a result, fetuses with urinary tract abnormalities generally develop normally before delivery. In addition, many kidney or urinary tract abnormalities detected before birth have no major impact on the overall health of the baby following delivery. Nevertheless, certain conditions may interfere with the baby's kidney function or growth after birth. For example, severely blocked flow of urine may damage the developing kidney and result in poor function after birth, a condition called dysplasia. If both kidneys are involved, the amount of urine may be seriously decreased. As a result, there may not be enough amniotic fluid surrounding the fetus, and its lungs may also be affected. 
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    A voiding cystourethrogram test is often done if a baby is born with a urinary tract abnormality. In this test, a thin tube called a catheter is inserted into your baby's bladder through the urethra, and the bladder is filled with x-ray dye. The catheter is then removed and x-rays are taken as the baby urinates. This test evaluates the baby's bladder and urethra, and also determines if reflux is present.
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    Ultrasound examinations are often done as part of prenatal care. This test allows the doctor to examine babies before they are born. With ultrasound, the doctor can see the fetus's internal organs, including the kidneys and urinary bladder. Occasionally, an abnormality is detected in the developing urinary tract. A doctor can then determine whether treatment is necessary. Parents should know that, in many cases, these abnormalities do not have a major impact on the child's overall health. 
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    If your baby is born with a congenital urinary tract abnormality, your doctor will examine your baby carefully and request certain tests to find out more about your baby's condition. The baby's blood pressure will be measured using an infant blood pressure cuff. Often, after the baby is born a more clear ultrasound is able to be performed to examine the baby's kidneys and bladder.

    Another test that is often done is called a voiding cystourethrogram. In babies who have hydronephrosis, a type of x-ray called a renal scan is often done. 
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    A Surgery, answered on behalf of

    Traditional treatment is to reconfigure the bladder as a sphere in the first 48 hours of life and to bring the widened pubic bones together. At a later date construction of the bladder neck as well as the correction of reflux should be performed. In the third stage the penile abnormality is repaired.

    This is technically demanding surgery and requires dedicated commitment to follow-up by both the treating physician and the family. At times, several of these procedures can be combined under the same anesthesia, and in fact in many instances the exstrophy and epispadias are repaired together in one surgery in the first 2 days of life. The ultimate goals are creation of a normally functioning bladder (including adequate volume, lack of reflux, and dryness) and a normally appearing and functioning penis. Some of the patients require augmentation (enlargement) of the bladder with a portion of the intestines.

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    Babies with urinary tract abnormalities detected by prenatal ultrasound often do very well. Nevertheless, babies with these conditions need careful evaluation following birth to see if treatment is necessary. Your baby may only need periodic visits to your doctor or a specialist in the treatment of children with congenital urinary tract abnormalities. Sometimes, a dose of antibiotics at bedtime is prescribed. Occasionally, infants with urinary tract abnormalities may need an operation to correct the problem. Your doctor can provide you with further information regarding congenital urinary tract abnormalities. 
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    A Surgery, answered on behalf of
    In rare cases, a combined obstetrical/urologic team needs to intervene prior to delivery to protect the development of the kidneys and lungs. Posterior urethral valves can be treated in the first few days after birth in almost all infants. A cystoscope is introduced in the urethra, and through the scope the valves are ablated. In many cases, long-term follow-up with the urologist is necessary.
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    In most fetuses with congenital urinary tract abnormalities, no treatment is needed until after delivery. However, your doctor may want to do repeated ultrasound examinations during pregnancy to monitor fetal kidney development.
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    Ureteropelvic junction (UPJ) obstruction is a condition in which blockage occurs at the junction where the ureter attaches to the kidney. This results in decreased flow of urine down the ureter and an increase of fluid pressure inside the kidney, which can cause deterioration of kidney function over time. The obstruction can be either congenital (the patient is born with it) or develop over time as a result of trauma or change in body shape with age. The blockage can be due to scar tissue, kinking, a blood vessel or rarely, a tumor.