Fetuses and newborns with malformations of the kidneys and urinary tract: problems and principles of patient management in the perinatal period

Congenital malformations (CM) of the urinary system (US) are embryonic disorders that occur during fetal development and result in various defects of the kidneys and urinary tract, including the ureters, bladder, and urethra. Congenital uropathies are among the most common congenital anomalies. The prognosis for the patient's life is extremely variable. The review presents modern data on the etiology, risk factors, pathogenesis, methods of antenatal diagnostics of congenital anomalies of the kidneys and urinary tract. Particular attention is paid to ultrasound examination in the ante- and postnatal periods, as well as diagnostic criteria for identifying patients at risk. The principles of examining patients in the postnatal period are described, as well as the difficulties in determining the tactics of management. A characteristic of various therapeutic strategies for preserving the function of the fetal US is given (vesicoamniotic shunting, intrauterine cystoscopy). Particular attention is paid to their mechanisms of action, as well as advantages and disadvantages. Currently, the current direction is the development of a single specific approach to the management of such patients, which is difficult to ensure due to the large number of variants of various anomalies. There is a need to prevent the formation of these conditions in fetuses, to mitigate the adverse effects of these CM in the ante- and postnatal periods and, consequently, to maintain good functional condition of the kidneys and ensure a high quality of life.