Hydronephrosis fetal

Administered by injection or inhalation during gestation nickel carbonyl caused fetal mortality, reduced pup weights, and fetal malformations including anophthalmia, microphthalmia, cystic lungs, and hydronephrosis in rats and hamsters. ... 

About 26% of the inhaled nickel was excreted in urine within 4 days absorption estimated at 50% Increased fetal mortality reduced body weight in live pups 16% incidence of fetal malformations (anophthalmia, microphthalmia, cystic lungs, hydronephrosis)... 

Dietary administration of 50 mg/kg/day FireMaster BP-6 to mice from gestation days 7 through 18 produced decreased fetal body weight and fetal abnormalities including exencephaly, cleft palate, and hydronephrosis 5 mg/kg/day did not produce significant developmental effects in this study (Corbett et al. 

Embryonic age Neural tube defects from retinoic acid, arsenic, and valproic acid (Adams, 1993 Bennett Finnell, 1998) Decreased fertility in female rats exposed to dioxin (TCDD) (Gray Ostby, 1995) Hydronephrosis with dioxin exposure during embryonic or fetal periods in rats (Couture-Haws et al., 1991 Bimbaum, 1995) ... 

The postnatal follow-up of fetal hydronephrosis has shown that more than half of the cases of hydronephrosis resolve spontaneously in utero or after birth. This evidence has led to a more conservative approach towards all uropathies and among them UPJ obstruction. On the other hand, many urologists stress the fact that early surgery would improve renal function, while others publish opposite conclusions, although they agree that pyeloplasty is safe in early life. 

Ectopic ureterocele develops at the lower end of the upper pole ureter of a duplicated kidney. It is a cyst-like thin-walled structure that is known to be mobile and variable in shape. During fetal life, the ureterocele can prolapse into the posterior urethra and create obstruction (Fig. 6.9). Bilateral hydronephrosis and megacystis can subsequently develop. Clinical diagnosis can be made at birth in girls with a perineal soft tissue mass, megacystis and bilateral urinary tract obstruction. Sonographic diagnosis can be difficult when the ectopic ureterocele has... 

Wyly JB, Lebowitz RL (1984) Refluxing urethral ectopic ureters recognition by the cyclic VCU. AJR 142 1263-1267 Yeung CK, Godley ML, Dhillon HK et al (1997) The characteristics of primary VUR in male and female infants with prenatal hydronephrosis. Br J Urol 80 319-327 Yu TJ, Chen W, Chen HY (1997) Early versus late surgical management of fetal reflux nephropathy. J Urol 157 1416-1419... 

Fig. 13.10a-c. VUR in utero. a Coronal view of the fetal trunk showing bilateral hydronephrosis (D) and unilateral ureteral dilatation (arrow). Ch, fetal chest. b,c Transverse scans of the fetal abdomen a few seconds apart showing variable dilatation of the renal pelvic dilatation, highly suggestive of VUR. Sp, spine... 

Morin L, Cendron M, Crombleholme M et al (1996) Minimal hydronephrosis in the fetus clinical significance and implications for management. J Urol 155 2047-2049 Mouriquand PDE, Troisfontaines E, Wilcox DT (1999) Antenatal and perinatal uronephrology current questions and dilemmas. Pediatr Nephrol 13 938-944 Muller F, Dommerguez M, Mandelbrot L (1993) Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies. Obstet Gynecol 82 813-820... 

Nolle CA, Bucket A, Adam GB et al (1992) Gd-enhanced MR-urography after low dose diuretic injection comparison with conventional EU. Radiology 209 147-157 Oliveira EA, Diniz JSS, Cabral ACV et al (1999) Prognostic factors in fetal hydronephrosis a multivariate analysis. Pediatr Nephrol 13 859-864... 

Fig. 14.2a-c. Male, 2 months old moderate bilateral fetal hydronephrosis, VCU. Reduced bladder filling volume (20 ml) residual urine early uninhibited detrusor contractions transformed into premature micturition, a Minor bladder trabecu-lation, short phase of normal micturition. b,c Dyscoordinated voiding, contraction of external urethral sphincter dilated posterior urethra, male spinning top urethra... 

Fetal hydronephrosis frequently is a transient feature, but postpartum renal US is needed in all. The majority of infants with significant postpartum findings have ureteropelvic obstruction. Followup studies with renal US and isotope investigations decide between the more frequently applied wait and see strategy and surgery. 

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