Five-Month Survival of Neonate After Serial Amnioinfusions for Fetal Bilateral Renal Agenesis [18D

Abstract

INTRODUCTION: Potter's syndrome secondary to bilateral renal agenesis, if untreated antenatally, was always thought to be a lethal prognosis for a singleton fetus within hours of delivery. However, Bienstock et al published the first and only case of long-term survival of a neonate born without kidneys due to the intervention of amnioinfusions and neonatal dialysis. The neonate needed minimal respiratory support at delivery at 28 weeks after preterm labor and met milestones at age 9 months. Only one other case report exists reporting an outcome for amnioinfusion for bilateral renal agenesis; published in 1994, prior to current advances in neonatal dialysis, the neonate delivered at 33 weeks gestation secondary to chorioamnionitis and died at 23 days from dialysis complications. METHODS: Case Report. RESULTS: A 28-year-old woman, gravida 2 para 1 multipara with history of delivery of a neonate with one kidney, was diagnosed at 21 weeks gestation with anhydramnios, fetal cardiomyopathy, and bilateral fetal renal agenesis. She underwent weekly amnioinfusions starting at 24 weeks gestation. At 30 weeks gestation, persistent fetal bradycardia was diagnosed at time of amnioinfusion necessitating emergent cesarean delivery. The neonate was born weighing 3 lb 11 oz with Apgars of 1, 4 and 6 and required intubation within 5 minutes of life. The neonate lived for five months on peritoneal dialysis and died from peritonitis secondary to perforation of a mucus fistula. CONCLUSION: Due to the paucity of data, we report our experience with amnioinfusion for bilateral renal agenesis as a contribution to the informed decision making process.