Uncovering new physiology in bilateral renal agenesis following amnioinfusion

Abstract

Background: Bilateral renal agenesis has uniformly been a lethal diagnosis in the perinatal or neonatal period. With the advent of more advanced renal replacement therapy as a bridge to renal transplantation, amnioinfusion has been explored at our center as a way to prevent lethal pulmonary hypoplasia secondary to oligohydramnios. Case presentation: We describe two cases of bilateral renal agenesis with serial amnioinfusion during pregnancy. The families opted for full neonatal intervention and post-natal renal support. While lethal pulmonary hypoplasia was avoided, early and refractory hypotension limited the ability to perform dialysis in these neonates. Conclusions: Our limited experience shows that barriers to care such as lethal respiratory failure and technical limitations of early dialysis are not the only barriers prohibiting care for this population.