Antenatally detected urinary tract abnormalities (AUTA)

The kidney and urinary tract account for 30% of all antenatally detected abnormalities, with the majority involving dilatation of the urinary tracts. In nearly 40% of cases, postnatal scans are normal and no further follow up is required. Of those with a confirmed postnatal abnormality a minority will develop hypertension, renal dysfunction, or require surgery.Once an abnormality has been detected, it is important that parents are counselled promptly by those with appropriate knowledge and experience of the suspected condition. Prognosis should be guarded as postnatal scans may reveal the abnormality to be more or less severe than expected. In some cases, the condition may affect the birth plan.Some children are at increased risk of urinary tract infection, so parents should be advised of the relevant symptoms and asked to contact their primary carer promptly (with a clean catch specimen if possible) for treatment if needed. Antibiotic prophylaxis is not routinely recommended but is appropriate in selected cases.This review gives an overview of the management of conditions most likely to be encountered by general paediatricians and includes algorithms for suggested management of children with dilatation of the urinary tract and those with unilateral kidney abnormality associated with a normal contralateral kidney.