VOL. 97, No. i
ANGIOGRAPHIC EVALUATION OF ANURIA
IN THE NEWBORN*
By MELVIN P. JUDKINS, M.D., and CHARLES T. DOTFER, M.D.
NURIA in the newborn is common dun- plete absence of kidneys, renal arteries, ureters,
ing the first 24 hours of life, being urinary bladder and urethra.
present in about 30 per cent of the infants.3
When persistent for a longer period of time,
it is usually due to such severe renal The reported incidence of bilateral renal
dysplasias as renal agenesis and polycystic agenesis is about i :,ooo births; 70 per
disease or complete obstruction of the cent are males.4 Most often these infants
urinary tract. It is important to diagnose are premature. If carried to term, little
definitively the presence or absence of the weight is gained after the 32nd week. The
occasional surgically correctable lesion. majority dies of respiratory failure within
Suprapubic puncture of the bladder, when a few hours. One infant has reportedly
positive, is an aid in making a diagnosis. lived for 3 days.7
Retrograde femoral aortography, how-
ever, is a relatively simple and precise
method of determining the presence of A normal kidney is formed only when a
renal parenchyma. Recently, such a pro- ureteral bud originates from the meso-
cedure performed on an anunic infant nephric duct and penetrates metanephro-
quickly established a definite diagnosis of genic mesoderm. The stimulus of the
bilateral renal agenesis. branching uneteral bud is essential for
the differentiation of this nephrogenic cap’
REPORT OF A CASE
(Fig. 2). Apart from rare hereditary ab-
I.H. (No. 33-83-90), a 3 day old, 1,785 gm. nonmalities, the primary cause of dys-
premature female of about o weeks’ gestation, plasia is developmental inhibition or ar-
was transferred to University of Oregon Med-
rest.’ The fetal kidney forms between the
ical School Hospital for evaluation. The infant
th and 7th weeks. It is during this period
became tachypneic 2 hours after delivery, but
was not cyanotic; a chest roentgenogram was that the developing kidney is vulnerable to
negative. Failure to void was soon noted; the environmental influences such as nutni-
blood urea nitrogen was 6 mg. per cent. The tional deficiencies and endocrine disturb-
suprapubic tap failed to recover urine. On ad- ances, on to infectious, chemical (drugs) and
mission, the infant’s respirations were labored. physical agents. Abortogenic drugs such as
The ears were deformed and low-set; there was the protoplasmic poison quinine may be a
edema about the eyes, and the left hip was dis- significant cause.
located. A urethral dimple was present, but the If the uretenic buds do not form, the
urethra was not patent. The provisional differ- metanephros (kidney) will not develop.
ential diagnosis was bilateral ureteropelvic ob- The absence of fetal urine results in oligo-
struction, urethral atresia or congenital renal
hydramnios, which in turn leads to posi-
agenesis. Emergency abdominal aortography
was performed (Fig. i, ii and B), and a diag- tional abnormalities of the extremities and
nosis of congenital bilateral renal agenesis was pulmonary hypoplasia. A characteristic
established. The infant expired of respiratory facial appearance is said to accompany the
failure at 6 days of age. The blood urea nitro- absence of renal function. “The face is
gen was 98 mg. per cent. Autopsy revealed corn- characterized by a prominent epicanthic
a From the University ofOregon Minthorn Memorial Laboratory for Cardiovascular Research through Radiology.
Aided by grants from the U. S. Public Health Service (H-3275 and H-6336 and 6F HD 23, 838), the Oregon Heart Association, and
240 Melvin P. Judkins and Charles T. Dotter MAY, 1966
per cent conrav through a PE I 20 catheter inserted via the right superficial femoral artery. (4) Arterial
phase. All of the usually recognized branches of the abdominal aorta except the renal arteries can be identi-
tied. (B) Nephrographic j)hase. A nephrogram is not observed.
fold, a flattelle(1 nose, large, imperfectly sence of kidney function rather than to a
formed ears set low 011 tIle ilead and often specific malformation. An’ infant with a
less upright than normal, afld an un- severe urinary tract dsplasia or anomaly,
pleasant, senile expression” (Potter’s s\n- therefore, ma present a similar appear-
drorne).4 a nce.
At least 8 per cent of infants with bi-
1)1 S C U S S I 0 N
lateral renal agenesis Ilave typical facial
characteristics.2 Ihis is related to tile ab- lile difterential diagnosis of an anunic
--Mesonephric duct fl.- .
5 WEEKS 6 WEEKS
FIG. 2. Diagram showing the early stages of the embryonic development of the urinary
tract (after Arey’).
VOL. 97, No. i Angiographic Evaluation of Anunia 241
state in a newborn includes such severe diagnosis of bilateral renal agenesis in a
dvsplasias and anomalies as renal agenesis, 1,785 gm. infant is reported.
polycystic disease, urethral atresia, and Melvin P. Judkins, M.D.
u netenovesi cal or u neteropelvic obstnu c- Department of Radiology
tion. The case reported did not present University of Oregon Medical School
entirely typical Potter’s facies. Because the 3 I 8 1 S.W. Sam Jackson Park Road
urethra was not patent, it was possible Portland, Oregon 97201
that an obstructive unopathy was present. REFERENCES
When there is a possibility that a surgically
I. AREY, L. B. Anatomy.
correctable lesion is present, aontography
edition. W. B. Saunders
can be used to determine quickly the delphia, 3954, pp. 68o.
presence of renal arteries on panenchyma. 2. BAIN, A. D., and SCOTT, J. S. Renal agenesis and
Even if the diagnosis is bilateral renal severe urinary tract dysplasia: review of 5o
agenesis, the clinician will be able to ad- cases, with particular reference to associated
anomalies.Brit. M. 7., 1960, i, 841-846.
vise the parents of the prognosis and can
3. CAMPBELL, M. F. Principles of Urology. W. B.
follow a conservative treatment plan. Saunders Company, Philadelphia, i 957.
4. POTTER, E. L. Facial characteristics of infants
SUMMARY with bilateral renal
agenesis. Am. 7. Obst. &
The differential diagnosis of anuria in Gynec., 1946, 51, 88-888.
5. POTTER, E. L. Bilateral absence of ureters and
the newborn over 24 hours of age includes kidneys. Obst. & Gynec., 3965, 25, 3-12.
severe renal dysplasia and complete un- 6. SYLVESTER, P. E., and HUGHES, D. R. Con-
nary obstruction. The latter is rare, but may genital absence of both kidneys; report of
be correctable. When it is reasonable to cases. Brit. M. 7., 1954, I, 77-79.
expect that significant information can be 7. WOOLF, R. B., and ALLEN, W. M. Concomitant
malformations ; frequent, simultaneous occur-
gained, aortography is indicated and feas-
rence of congenital malformations of reproduc-
ible even in a premature infant. tive and urinary tracts. Obst. & Gynec., 1953,
The use of angiography to establish the 2, 236-265.