the kidneys and urinary tract

Birth defects of the kidneys and urinary system (urinary tract) are more common than any other system of the body, and defects can occur in:

The kidneys (the two organs that filter waste from the blood to make urine)

The ureters (the two tubes that carry urine from the kidneys to the bladder)

Bladder (the expandable muscular sac that holds urine)

Urethra (the tube that drains urine from the bladder out of the body)

Complications of urinary tract defects

Urinary tract defects may lead to

Blockage or slowing of the flow of urine

Allowing urine to flow back from the bladder to the kidneys (urinary reflux)

Any birth defect that blocks or slows the flow of urine can make urine stagnant, which can lead to a urinary tract infection or the formation of kidney stones.

Urinary reflux usually occurs when the defect involves the junction, where the ureters connect to the bladder These two connectors (one for each ureter) usually allow urine to flow in only one direction, from the kidneys to the bladder. Defects of the junction can allow urine to flow backward from the bladder into the kidney (urinary reflux). In addition, other defects that block the flow of urine can increase pressure in the bladder and cause urinary reflux.

Urinary reflux disease or frequent infections can damage the kidneys and ureters over time. Kidney damage can cause high blood pressure and, in rare cases, kidney failure.

Severe defects of the urinary tract in the fetus can cause little or no urine production, and the fetus''s urine becomes part of the fluid that surrounds it in the womb (called amniotic fluid). If the fetus does not release enough urine, the amount of amniotic fluid decreases. If the amount of this fluid is too small, the lungs, heart, face, and limbs may develop abnormally. Severe defects can cause death while the fetus is in the womb or shortly after birth.

Symptoms

Many urinary tract defects cause no symptoms and are often only discovered when imaging studies are done for other reasons, or during a well-child examination. Some kidney defects don''t cause problems or become apparent until adulthood.

When defects in the urinary tract cause symptoms, children may have

blood in the urine (hematuria)

Frequent symptoms of urinary tract infection

Frequent involuntary urination (urinary incontinence)

Abdominal pain or vomiting due to obstruction of urine flow

Children who have blocked urine flow also have an increased risk of significant urinary bleeding after a minor injury, because the kidneys are under pressure.

the diagnosis

Prenatal, ultrasonography and prenatal blood tests

After birth, imaging tests and sometimes cystoscopy

Sometimes voiding cystourethrography

Before birth, doctors often find urinary tract defects during prenatal ultrasonography or other routine imaging tests to check for genetic disorders.

After birth, if doctors suspect a urinary defect in a child, they usually use imaging tests such as ultrasonography, computed tomography, nuclear scans, magnetic resonance imaging, and, rarely, intravenous urography or cystoscopy, and for cystoscopy, doctors examine the bladder and urethra From the inside through a flexible viewing tube called a cystoscope (a type of endoscope).

To diagnose certain defects of the urinary tract, doctors sometimes do a test called VCUG. This procedure involves passing a catheter through the urethra into the bladder, an X-ray contrast agent is placed through the catheter, and doctors do an X-ray before and after the child urinates.

processing

Sometimes surgery

Defects that cause symptoms or lead to increased pressure in the kidneys or bladder usually need to be corrected surgically.