EP17.11: Oligohydramnios with multiple cysts of bilateral fetal kidneys during pregnancy without evidence of pulmonary hypoplasia after birth: a case report

Fetal bilateral multicystic dysplastic kidney (MCDK) may be accompanied by oligohydramnios and pulmonary hypoplasia leading to poor postnatal prognosis. We report our experience with a case of severe oligohydramnios with multiple cysts in the bilateral kidneys but no evidence of postnatal pulmonary hypoplasia and good prognosis immediately after delivery. She was the 22-year-old primigravid woman with natural pregnancy and no particular medical or family history. At 25 weeks of gestation, fetal ultrasound revealed oligohydramnios, bilateral renal enlargement, and multilocular cysts with urine retention in the bladder but no other morphological abnormalities. Magnetic resonance imaging at 26 weeks of gestation showed similar findings in the fetal kidneys; therefore, pulmonary hypoplasia and polycystic kidney disease or MCDK were suspected. Findings during the subsequent clinical course showed additional reduction in the amniotic fluid volume. Although the amniotic fluid index (AFI) was virtually impossible to measure, urine retention was noted in the bladder. At this point in time, we explained that the condition was not considered fatal as the urinary bladder was visible in the images. At 38 weeks of gestation, labour was induced, and vaginal delivery was performed. The newborn was treated with mask CPAP because of retractive breathing at birth and admitted to the NICU. Chromosomal tests performed after birth revealed a normal karyotype. Ultrasonoscopy, renal scintigraphy revealed MCDK in the left kidney; however, the right kidney showed renal parenchymal structure, despite the number of cysts. A definitive diagnosis has not yet been determined. The present case demonstrated oligohydramnios with multiple renal cysts in the bilateral fetal kidneys; however, our observations show that if urine retention in the bladder, postnatal pulmonary hypoplasia may not develop and the prognosis immediately after birth could be good.