Abstract
The fetal urinary tract is routinely evaluated sonographically beginning in the first trimester with documentation of fetal bladder visualization. Fetal MR might be indicated to further clarify abnormalities found sonographically. The primary imaging modality for evaluation of the fetal kidney is US, which plays an important role in the detection of collecting system dilatation and parenchymal diseases that influence counseling and postnatal care. A commonly seen birth defect affecting the fetal kidney is pyelectasis. The significance of this finding has been extensively evaluated by a number of fetal imaging centers and will be presented in this review. Further topics of interest within the fetal genitourinary system include fetal renal parenchymal disorders and fetal bladder abnormalities. Characteristic imaging features, as well as developmental pathology and differential considerations, are discussed here.
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Herndon CDA, McKenna PH, Kolon TF et al (1999) A multicenter outcomes analysis of patients with neonatal reflux presenting with prenatal hydronephrosis. J Urol 162:1203–1208
Persutte WH, Koyle M, Lenke RR et al (1997) Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant. Ultrasound Obstet Gynecol 10:12–18
Kent A, Cox D, Downey P et al (2000) A study of mild fetal pyelectasia: outcome and proposed strategy of management. Prenat Diagn 20:206–209
Sairam S, Al-Habib A, Sasson S et al (2001) Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 17:191–196
Ismaili K, Hall M, Donner C et al (2003) Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol 188:242–246
Odibo AO, Raab E, Elovitz M et al (2004) Prenatal mild pyelectasis evaluating the thresholds of renal pelvic diameter associated with normal postnatal renal function. J Ultrasound Med 23:513–517
Lee RS, Cendron M, Kinnamon DD et al (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593
Koff SA (1987) Problematic ureteropelvic junction obstruction. J Urol 138:390–397
Lebowitz RL, Olbing H, Parkkulainen KV et al (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109
Maizels M, Reisman ME, Flom LS et al (1992) Grading nephroureteral dilatation detected in the first year of life: correlation with obstruction. J Urol 148:609–614, discussion 615–616
Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480
Blane CE, DiPietro MA, Zerin JM et al (1993) Renal sonography is not a reliable screening examination for vesicoureteral reflux. J Urol 150:752–755
Tibballs JM, DeBruyn R (1996) Primary vesicoureteral reflux: how useful is postnatal ultrasound? Arch Dis Child 75:444–447
Aksu N, Yavascan O, Kangin M et al (2005) Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol 20:1253–1259
Mallik M, Watson AR (2008) Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol 23:897–904
Benacerraf BR, Mandell J, Estroff J (1990) Fetal pyelectasis: a possible association with Down syndrome. Obstet Gynecol 76:58–60
Nyberg DA, Resta RG, Luthy DA et al (2001) Isolated sonographic markers for detection of fetal Down syndrome in the second trimester of pregnancy. J Ultrasound Med 20:1053–1063
Bromley B, Lieberman E, Shipp TD et al (2002) The genetic sonogram: a method of risk assessment for Down syndrome in the second trimester. J Ultrasound Med 21:1087–1096
American College of Obstetricians and Gynecologists (2007) Screening for fetal chromosomal abnormalities. Washington (DC): American College of Obstetricians and Gynecologists (ACOG practice bulletin; no. 77)
Flashner SC, King LR (1976) Ureteropelvic junction. In: Clinical pediatric urology. WB Saunders, Philadelphia, PA, p 693
Association AU (2010) Screening of the neonate/infant with prenatal hydronephrosis. American Urological Association Education and Research Inc., Bulletin Topic, 5
Ebel KD (1998) Uroradiology in the fetus and newborn: diagnosis and follow-up of congenital obstruction of the urinary tract. Pediatr Radiol 28:630–635
O’Reilly P, Aurell M, Britton K et al (1996) Consensus on diuresis renography for investigating the dilated upper urinary tract. Radionuclides in Nephrourology Group. Consensus Committee on Diuresis Renography. J Nucl Med 37:1872–1876
Cullen-McEwen LA, Caruana G, Bertram JF (2005) The where, what and why of the developing renal stroma. Nephron Exp Nephrol 99:1–8
Rosenblum ND (2008) Developmental biology of the human kidney. Seminar Fetal Neonatal Med 13:125–132
Rodriguez MM (2004) Developmental renal pathology: its past, present, and future. Fetal Pediatr Pathol 23:211–229
Ingraham SE, Saha M, Carpenter AR et al (2010) Pathogenesis of renal injury in the megabladder mouse: a genetic model of congenital obstructive nephropathy. Pediatr Res 68:500–507
Wang X, Zhou Y, Tan R et al (2010) Mice lacking the matrix metalloproteinase-9 gene reduce renal interstitial fibrosis in obstructive nephropathy. Am J Physiol Renal Physiol 299:973–982
Aslam M, Watson AR (2006) Unilateral multicystic dysplastic kidney: long term outcomes. Arch Dis Child 91:820–823
Bergmann C, Senderek J, Kupper F et al (2004) PKHD1 mutations in autosomal recessive polycystic kidney disease (ARPKD). Hum Mutat 23:453–463
Bergmann C, Senderek J, Windelen E et al (2005) Clinical consequences of PKHD1 mutations in 164 patients with autosomal-recessive polycystic kidney disease (ARPKD). Kidney Int 67:829–848
Wilson PD (2004) Polycystic kidney disease. N Engl J Med 350:151–164
Reuss A, Wladimiroff JW, Stewart PA et al (1990) Prenatal diagnosis by ultrasound in pregnancies at risk for autosomal recessive polycystic kidney disease. Ultrasound Med Biol 16:355–359
Liu YP, Cheng SJ, Shih SL et al (2006) Autosomal recessive polycystic kidney disease: appearance on fetal MRI. Pediatr Radiol 36:169
Mashiach R, Davidovits M, Eisenstein B et al (2005) Fetal hyperechogenic kidney with normal amniotic fluid volume: a diagnostic dilemma. Prenat Diagn 25:553–558
Tsatsaris V, Gagnadoux MF, Aubry MC et al (2002) Prenatal diagnosis of bilateral isolated fetal hyperechogenic kidneys. Is it possible to predict long term outcome? Br J Obstet Gynaecol 109:1388–1393
Woolf A (2008) Perspectives on human perinatal renal disease. Seminar Fetal Neonat Med 13:196–201
Decramer S, Parant O, Beaufils S et al (2007) Anomalies of the TCF2 gene are the main cause of fetal bilateral hyperechogenic kidneys. J Am Soc Nephrol 18:923–933
Sebire N, Kaisenberg CV, Rubio C et al (1996) Fetal megacystis at 10–14 weeks of gestation. Ultrasound Obstet Gynecol 8:387–390
Bronshtein M, Kushnir O, Ben-Rafael Z et al (1990) Transvaginal sonographic measurement of fetal kidneys in the first trimester of pregnancy. J Clin Ultrasound 18:299–301
Rosati P, Guariglia L (1996) Transvaginal sonographic assessment of the fetal urinary tract in early pregnancy. Ultrasound Obstet Gynecol 7:95–100
Sepulveda W (2004) Megacystis in the first trimester. Prenatal Diagn 24:144–149
Yiee J, Wilcox D (2008) Abnormalities of the fetal bladder. Semin Fetal Neonat Med 13:164–170
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The supplement this article is part of is not sponsored by the industry. Dr. Chapman has no financial interest, investigational or off-label uses to disclose.
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Chapman, T. Fetal genitourinary imaging. Pediatr Radiol 42 (Suppl 1), 115–123 (2012). https://doi.org/10.1007/s00247-011-2172-6
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DOI: https://doi.org/10.1007/s00247-011-2172-6