In the U.K., pregnant women are usually routinely scanned at about 12 weeks (the “dating” scan) and 18-20 weeks (the “anomaly” scan). An “abnormality” of the urinary tract is found in 1:500 scans and is therefore very common. The majority of these findings will be a transient swelling, or “hydronephrosis”, of one of both kidneys, but rarer more serious conditions could be discovered. In an effort to relieve parental anxiety and smoothen the transition between prenatal diagnosis and postnatal investigation and management, I have revised the guidelines for management of such cases in Chelsea and Westminster and Imperial College Hospitals. I also provide advice to a number of North West London Hospitals including the Hillingdon and Northwick Park.

I currently carry out prenatal counselling clinics in Chelsea and Westminster and Queen Charlotte’s Hospitals, and review the babies once they are born in one of my clinics in C&W, St Mary’s or the Hammersmith Hospital. The prenatal clinics are held in conjunction with the fetal medicine doctors who scan the pregnant mum. I then provide information about the kidney findings and what that would mean for the baby. If the baby needs further investigation once it is born, I would organise to see him/ her in one of my urology clinics.

At birth, babies are usually started on a very low dose of “prophylactic” (preventative) antibiotic, usually Trimethoprim, every evening. The antibiotic protects the baby against urinary tract infections (UTI) until we carry out the necessary investigations. The dose is a quarter of the normal dose and will not harm the baby, affect its immunity, or give it any side effects. On the other hand, a UTI in a new born, when the kidneys are still developing, can be very serious. The timing and type of scans we organise will depend on whether the swelling affects one or both kidneys, and whether it affects the ureters (tubes leading from kidney to bladder) and the bladder itself. In the majority of cases, the babies are discharged home and brought back for their scans at 1-2 weeks of age. In a few cases, in particular boys with swelling of both kidneys and bladder, the baby will require admission for a few days until the scans are done.

The commonest causes for prenatally-diagnosed renal tract abnormalities are: a transient, self-limiting swelling due to the increased fetal urine output in the third trimester of gestation; a blockage at the level of the kidney (pelvi-ureteric junction obstruction) or bladder (vesico-ureteric junction obstruction); a blockage to the outflow of the bladder (posterior urethral valves); or backflow of urine up into the kidney (vesicoureteral reflux).

  • Contact

  • NHS Referrals

    NHS Referrals

    Please visit your GP and request a referral to Chelsea & Westminster Hospital Paediatric Urology

  • Private Referrals

    Miss MK Farrugia

    Please e-mail [email protected] or book an appointment in Chelsea & Westminster Hospital (0203-315-8599) or BUPA Cromwell Hospital (0207-460-5700)