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[Acute Kidney Failure Due to Urachal Cyst?]

I Klaassen1, M Wolf1, M J Kemper2

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A persistent urachal cyst caused severe urinary obstruction and renal impairment in a newborn with trisomy 21. Surgical removal of the cyst and treatment for a posterior urethral valve led to complete renal recovery.

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Area of Science:

  • Pediatric Surgery
  • Neonatal Urology
  • Medical Imaging

Background:

  • A newborn presented with suspected fetal malformation, prenatal renal impairment, and anhydramnios.
  • The infant also exhibited external stigmas of trisomy 21 and progressive postnatal renal impairment with anuria.

Observation:

  • Prenatal ultrasound showed unilateral renal agenesis and an undetectable bladder.
  • Postnatal ultrasound revealed enlarged kidneys with impaired perfusion and a rosette-shaped structure in the lower abdomen.
  • Exploratory laparotomy identified the structure as a persistent urachal cyst obstructing the upper urinary tract.

Findings:

  • Surgical removal of the urachal cyst and bladder reconstruction led to complete renal function recovery.
  • A subsequent voiding cystourethrogram unexpectedly diagnosed a posterior urethral valve, which was treated surgically.
  • The exact cause of initial renal failure remains unclear, possibly due to the urachal cyst's mass effect or a masked proximal stenosis.

Implications:

  • This case highlights the importance of investigating unusual abdominal structures in neonates with renal dysfunction.
  • Prompt surgical intervention for urachal cysts and associated urinary anomalies can lead to favorable renal outcomes.
  • The interplay between urachal cysts and posterior urethral valves in neonatal renal failure warrants further investigation.