Renal failure after single fetal demise in monochorionic twins: incidence and description of a case

Single intrauterine fetal demise in monochorionic (MC) twins may result in acute exsanguination from the surviving twin into the low-pressure circulation of the demised co-twin through the vascular anastomoses. This may lead to severe hypoxic-ischemic injury in the surviving twin due to hypovolemia, hypotension and anemia, resulting in multiorgan damage. Most studies in single fetal demise in MC twin pregnancies have reported on the risk of cerebral injury. The aim of our study was to explore the incidence and severity of renal damage in surviving MC twins after intrauterine co-twin death. We reviewed all cases of MC twins with single fetal demise presented over a 10-year period at our center. One of the 44 (2.3%) surviving co-twins was diagnosed with severe renal damage. We describe this case in detail, as it provides valuable insights into the pathogenesis of renal and other organ failure after MC co-twin death.