Background Congenital anomalies of kidney and renal tract (CAKUT) constitute 20–30% of all anomalies identified perinatally. CAKUT play causative role in 30–50% chronic kidney disease requiring renal replacement treatment in children. Majority of these anomalies are not life threatening. It is important to diagnose and initiate treatment early to prevent progression to end stage renal disease

Objectives

• To collect data on antenatally diagnosed renal anomalies and their demographics at our centre.

• To study the six-month outcome of foetuses identified with renal pelvic dilatation (RPD).

• To identify areas of improvement and implement changes.

Methods We identified cases from records of prenatal multi-disciplinary team (MDT) meetings from January to December 2019. Data was retrospectively collected from our hospital database, maternal and neonatal records, laboratory and radiology results and clinic letters.

Results 46 foetuses with renal anomalies were discussed in the MDT, 11 discharged antenatally, 1 moved home. 34 were included in the study (n=34).

Foetuses with bilateral(B/L) RPD:

9 foetuses were diagnosed with B/L RPD, 8 were male and 1 female.

5 needed urgent renal ultrasound – 100% done within 24–48 hrs, 4 needed routine scans, all done between 1–4 weeks.

8 were started on antibiotic prophylaxis.

First postnatal scan showed B/L RPD in 2, U/L RPD in 4 and normal in 3.

Further investigations done included MCUG in 5, MAG3 scans in 3 and DMSA in 1.

At 6 months, antibiotic prophylaxis was stopped in 5 and discharged from care, 1 had planned follow up with paediatrician at 1 year and 3 had ongoing care under urology.

Foetuses with unilateral(U/L) RPD

12 foetuses with U/L RPD± Calyceal/ureteral involvement.

10 were male, 2 females.

11 had routine renal US. First ultrasound findings were normal in 5, unilateral RPD in 3, duplex kidney in 1, hydronephrosis in 2.

1 had urgent scan on day 1, which revealed mild calyceal fullness in absence of RPD.

10 were started on trimethoprim prophylaxis. At six months, prophylaxis was stopped in 7, continued in 1 and not specified in 2.

Conclusions In B/L RPD, targets for prophylaxis were met in 96.4%, and in 100% patients for urgent scans. No cases on posterior urethral valves were diagnosed in the study period.

In U/L RPD, targets for scan were met in 100% and 91.6% for antibiotic prophylaxis.

To improve compliance with prophylactic antibiotics, our Trust patient information leaflet on RPD is modified to add information on antibiotic prophylaxis and more stringent measures are taken to update the neonatal team about antenatal diagnoses.