Chapter 98 Genitourinary System (See Also Part XXIV)

Urinary tract anomalies (hydronephrosis, dysplasia, agenesis, cystic or solitary kidney) can be identified by prenatal ultrasonography (see Table 90-1). After birth, the presence/extent of anomalies needs to be confirmed and followed by detailed evaluation and appropriate management. Multicystic and polycystic forms of kidney disease have high risk for mortality and renal morbidity. In contrast, the majority of mild dilatations have no clinical consequences but cause unnecessary anxiety in many cases.

One or both kidneys are often easily palpable in a newborn infant. When both are palpable and similar, infants usually do not have any particular diagnostic problems, but when only one kidney can be felt, a frequent impression is that it is larger than normal or is displaced by an intrinsic or extrinsic mass. Fetal lobulation may contribute to this impression. The problem usually resolves as the kidney becomes progressively less easily palpable during the early months of life. Because palpable enlargement or displacement of a kidney in a newborn may be due to hydronephrosis, neuroblastoma, mesoblastic nephroma, adrenal hemorrhage, or a cystic malformation, ultrasound examination is indicated.

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