An 8-Hour-Old Boy Is Evaluated in the Neonatal Intensive Care

An 8-hour-old boy is evaluated in the neonatal intensive care unit due to respiratory distress.  The infant was born at term to a 32-year-old woman, gravida 3 para 2.  The mother's routine serologic screening in the first trimester was unremarkable except for a lack of antibody against rubella.  The pregnancy was complicated by oligohydramnios.  Antenatal sonography at 19 weeks gestation showed that the fetal kidneys were in the normal position but moderately dilated and that the bladder was also dilated and had a thickened wall.  Growth measurements were appropriate for gestational age.  The delivery was uncomplicated, but immediately after birth, the infant developed some mild respiratory distress that is now improving.  Weight is 3.35 kg (7 lb 6 oz) and respirations are 70/min.  The infant is tachypneic but otherwise comfortable, with no grunting or retractions.  The bladder is palpable just above the suprapubic ridge.  The remainder of the examination is unremarkable.
Which of the following is the most likely diagnosis in this infant?

A) Autosomal recessive polycystic kidney disease
B) Duplicated collecting system
C) Posterior urethral valve
D) Ureteropelvic junction obstruction
E) Vesicoureteral reflux

Correct Answer:

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