Even if normal kidney (renal) and urinary function is present at birth, this does not mean that potential problems can’t develop in the future. In some cases, kidney and urinary problems do not produce symptoms until chronic kidney disease has already developed. So, careful management and follow up care for children with ARM is critical to their health.
To assess risks and to possibly prevent future issues, infants with ARM should undergo diagnostic testing shortly after birth to check their urologic health.
These tests include:
- Renal tract ultrasound
- X-rays of the sacrum (the area at the bottom of the spine)
- Voiding cystourethrogram (VCUG): a test that uses a combination of X-ray and fluoroscopy to visualize a child's urinary tract and bladder
- Spinal ultrasound and/or MRI (depending on the age of the patient) to check for abnormalities
Following surgical treatment for ARM, children should have regular annual check-ups. Monitoring at outpatient visits should include:
- Urological history, including whether the child has had urinary tract infections and the development or loss of urinary continence
- Annual renal tract ultrasound, a test that is performed if hydronephrosis (swelling of the kidney due to a build-up of urine) or scarring is present
- Annual renal blood work
- Screening questions about symptoms related to a tethered spinal cord
- Possible urodynamics testing, which are studies that show how well the bladder, sphincters, and urethra hold and release urine