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Abstract
Fetal urinary tract anomalies are a common finding, occurring in 0.2% to 1.5% of all pregnancies.
Congenital obstructive nephropathy is a common and highly variable disorder that accounts for a large fraction of progressive renal disease in children. While factors responsible for malformations of the urinary tract remain poorly understood, much progress has been made in understanding the mechanisms of injury to the developing kidney with an obstruction to urine flow. Further elucidation of these molecular processes will lead to the development of new biomarkers and new therapies to prevent the progression of lesions and to enhance remodeling of the kidney following surgical correction of obstruction.
Neonatal hydronephrosis remains a clinical challenge with a wide grey zone. Determining when persistent postnatal hydronephrosis will result in renal damage needs clinical judgment and careful observation. Although a majority of postnatal hydronephrosis will resolve spontaneously, selecting the group of children that will not resolve , requires careful follow-up and good clinical judgment. With future clinical and basic science research, the hope is that the grey zone can become narrower, allowing for better selection of appropriate patients for observation and for surgical intervention.
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