Perspectives on human perinatal renal tract disease.

Perinatal renal tract disease is the main cause of end-stage renal failure in children. The diagnosis also includes many disorders of lesser severity, which may cause morbidity, such as hypertension, in later life. There remain uncertainties in the accuracy of some fetal diagnoses, and the life-time outcomes of children born with renal tract disease, who survive the neonatal period, are not known. There is a need for prospective trials to establish the efficacy, if any, with regard to protection of long-term kidney function of existing 'therapies', such as prenatal surgical decompression and postnatal drugs, which might slow the progression of renal failure. Specific drugs, which may block the growth of renal cysts, are being tested in humans. Advances in genetics are uncovering specific mutations in some children with renal tract malformations, providing parent and carers with explanations for the occurrence of such diseases.