Diagnostic and therapeutic approach in uropathic abnormalities diagnosed in utero

Ultrasonography permits to suspect urinary tract abnormalities in fetal age: hydronephrosis is one of the most frequent anomalies detected, but renal dysplasia (multicystic kidney, renal agenesis, renal cysts) can be found in some cases. At birth, if abnormalities are confirmed by ultrasound scan other instrumental investigation are needed: cystography, to exclude vesicoureteric reflux, and sequential scintigraphy, to evaluate if obstruction of urinary tract is present or to confirm the suspect of renal agenesis or multicystic dysplasia. Urography could be necessary in some cases. For bilateral uropathy evaluation of renal function with blood tests is required. Early surgery is needed in case of severe obstructive uropathy; if obstruction is mild the patients can be followed with instrumental investigation. Antibiotic prophylaxis is required to prevent urinary tract infections in patients with vesicoureteric reflux. The indications for surgery in patients with vesico-ureteric reflux are still unclear.