Review Question - QID 214696

A newborn girl is brought to a rural urgent care clinic after the parents noticed abnormal fussiness. The patient was born 3 hours prior after a home spontaneous vaginal delivery, and has become increasingly agitated. The mother reports that this is her third child, and that the pregnancy had been unremarkable. The mother had presented for a single prenatal visit but had been lost to follow up for the last 20 weeks. On exam, the temperature is 98.6°F (37.0°C), blood pressure is 70/40 mmHg, pulse is 140/min, and respirations are 40/min. The patient weighs 2 kg (4.41 lbs). The patient is moving all extremities and is crying. The lower abdomen is slightly distended, and palpation worsens the patient’s agitation. Ultrasound demonstrates bilateral hydronephrosis but is otherwise unremarkable. There are no anomalies with the bladder. What is the most likely cause of this patient’s disease?