PRENATAL FAILURE TO VISUALIZE KIDNEYS - A SPECTRUM OF DISEASE

Objectives. To better understand the outcomes and management of patien ts when there is a failure to visualize kidneys on prenatal ultrasound . Methods. Nine thousand five hundred twelve prenatal ultrasound studi es performed on 4900 patients were reviewed retrospectively for the fi ndings of a failure to visualize kidneys. The prenatal ultrasounds, pr egnancy outcomes, and postmortem studies were reviewed for each of the 10 patients identified. Results. Nine of 10 patients experienced feta l death in the index pregnancy: 7 had therapeutic abortions, 1 had an intrauterine fetal demise, and 1 gave birth to a stillborn infant. One patient gave birth to a live infant with Bartter's syndrome and gross ly normal kidneys, as diagnosed by ultrasound. Developmental renal ano malies were identified in only 4 of 10 cases, and only 2 patients had true bilateral renal agenesis. There was 1 case each of bilateral rena l medullary cystic dysplasia and bilateral renal hypoplasia. Three cas es had no renal anomalies and included 1 case each of Turner's syndrom e, chronic abruption, and a cord accident. In 2 cases, postmortem exam inations were not performed because of family wishes. Conclusions. Pre natal failure to visualize kidneys represents a spectrum of clinical p roblems not all of which are fatal. Close consultation with an experie nced ultrasonographer is essential to provide informed counseling to e xpectant parents. Pathologic examination should be recommended when th ere is fetal demise and a suspicion of genitourinary anomalies. Screen ing of family members of the index patient and genetic counseling may be indicated. UROLOGY 52: 306-311, 1998. (C) 1998, Elsevier Science In c. All rights reserved.