Sonography of bilateral renal agenesis in a fetus:

This is yet another case of bilateral renal agenesis.
This case is presented by Dr. Ajit Athale, MD, from Baroda, India. He describes the findings nicely. These images are of a fetus of 28 weeks.
Here we can see the "LYING DOWN" ADRENAL SIGN, the diagnostic finding ofof renal agenesis. In renal agenesis, the adrenals are free to occupy the space left in the renal fossa. So instead of being horizontal & being contoured frombelow by the upper pole of kidneys, they become vertical and flat, literally, plate like. This flattening of the adrenals is an indirect sign that the kidneys did not develop in the flanks. In fact, even on postmortem, I (Dr. Ajit) have seen pathologists mistaking gross specimen of discoid shaped adrenals as kidneys in case of bilateral renalagenesis, only to be corrected later on- by microscopy.This sign is of particular importance when one is notsure as to presence or absence of kidneys.Sometimes domes of diaphragm can masquerade as upperpoles of kidneys, especially when fetus is breathing (as shown in one of my pictures).This fetus also had club foot.

For more on this topic and view some more ultrasound images of renal agenesis, please visit my gallery of ultrasound images at:
http://drjoea.googlepages.com/obstetric-2

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