Unilateral macrocystic dysplasia and contralateral agenesis in a monochorionic twin

Abstract

Objective: We present a case report of a congenital malformation of the uropoietic tract in one of the monochorionic twins. Case report: A 24-year-old primigravida with male monochorionic monoamniotic gemini was diagnosed with congenital malformation in fetus A at 24 weeks of gestation. Ultrasound verified macrocystic dysplasia and contralateral renal agenesis. Planned caesarean section was performed after the observational management of the patient in the 34th gestational week. On postpartum ultrasonography was confirmed a physiological finding in fetus B. In fetus A, CT examination of the abdomen confirmed the finding of left kidney agenesis and polycystic degeneration of the right kidney. Exitus letalis was stated on the newborn's fifth day. Conclusion: The occurrence of the described combination of congenital malformation in monoamniotic twins is rare. When dysplasia significantly affects the function of the parenchyma, renal agenesis with multicystic dysplasia of the other kidney is a condition incompatible with life. For the intrauterine survival of the affected fetus, the normal renal function of the twin was important and thus the normal volume of amniotic fluid was maintained. As a result, the fetus did not develop extrarenal symptoms of the Potter sequence in the described case - especially pulmonary hypoplasia and the newborn was able to spontaneously ventilate. The death was due to the consequences of renal failure associated with anuria.

Key words: monochorionic gemini, macrocystic renal dysplasia, renal agenesis