Developmental renal pathology: its past, present, and future.

Congenital anomalies of the kidney and urinary tract are responsible for approximately 40% of cases of childhood end-stage renal failure in the United States. This article describes the spectrum of developmental renal lesions in children (including renal agenesis, dysplasias, hereditary hydronephrosis, autosomal recessive and dominant polycystic kidneys, vesicoureteral reflux, diabetic embryopathy, some teratogenic drugs affecting renal development, and syndromes associated with renal dysplasias). The article quotes some historic references that established the foundation for further studies; reviews the embryology, pathology, postnatal renal development, and its possible consequences of renal function; as well as recent advances in fetal ultrasonography and molecular biology with some novel treatment and diagnostic modalities. Finally, an attempt is made to predict several future avenues in pharmacogenetics that are being built currently and that will allow a better prognosis for many children with congenital renal conditions.