The British Journal of Radiology, 80 (2007), e167–e169

CASE REPORT

Renal agenesis: report of an interesting case

A MISHRA, MBBS, MD

National Organ Transplant Program, Tripoli Central Hospital, Tripoli, Libya

ABSTRACT. Renal agenesis is generally thought to result from a lack of induction of the
metanephric blastema by the ureteral bud, which may be secondary to ureteral bud Received 10 January 2006
maldevelopment and/or to a problem with the formation of the mesonephric duct. Revised 22 March 2006
Uncommonly, post-natal involution of multicystic dysplastic kidneys results in solitary Accepted 24 April 2006
kidney. Unilateral renal agenesis may be associated with ipsilateral genitourinary
DOI: 10.1259/bjr/79912069
anomalies and VATER abnormalities. The interest of this case lies in the association of
unilateral renal agenesis with the presence of an ipsilateral pelvic dilated ureter, ’ 2007 The British Institute of
ipsilateral seminal vesicle hypoplasia and absence of the vas deferens. Radiology

Renal agenesis is a relatively common congenital
anomaly, although its aetiology is unknown. Renal
agenesis may be unilateral or bilateral. Bilateral renal
agenesis/dysgenesis (BRA/D) is a rare anomaly occurr-
ing in only one or two per 10 000 births. Unilateral renal
agenesis is usually an incidental finding with the
contralateral kidney demonstrating compensatory
hypertrophy. Renal agenesis is generally thought to
result from a lack of induction of the metanephric
blastema by the ureteral bud. Sometimes solitary kidney
may be the result of post-natal involution of multicystic
dysplastic kidney. Renal agenesis is associated with
ipsilateral urogenital anomalies. Associated ipsilateral
adrenal agenesis is seen in 8–10% of cases. An unusual
case is reported here of unilateral renal agenesis
associated with ipsilateral absence of the vas deferens
and hypoplasia of the seminal vesicle and presence of an
ipsilateral dilated pelvic ureter.
Case report
A 30-year-old young healthy man of normal build
presented to the outpatients’ department in surgery with
vague abdominal pain of 6 months’ duration, but not
associated with colic. No significant past medical history
was present. No history of urinary symptoms was
elicited. Physical examination revealed a healthy indivi-
dual of normal build. Systemic examination revealed
mild fullness of the left renal angle. Routine laboratory
studies including urine and stool examination did not
reveal any abnormality.
Routine ultrasound examination showed an empty right
renal fossa with compensatory hypertrophy of the left
kidney. The right kidney could not be localized in the
abdomen or pelvis. The distal third part of the right ureter
was demonstrated with normal vesico-ureteric junction.
The ureter was, however, dilated. The right seminal vesicle
Address correspondence to: Dr Anuj Mishra, PO BOX 7913,
Ainzara, Alfurnaz, Tripoli, Libya. E-mail: dranujmish@yahoo.com
was hypoplastic and cystic compared with the contral-
ateral seminal vesicle. The right vas deferens also was not
visualized (Figure 1). On multislice CT, the right kidney
could not be seen in the abdomen or pelvis and the right
renal fossa was occupied by colonic loops. CT angiography
showed an absent right renal artery and renal vein. CT
urography revealed absence of the right ureter and
absence of filling of the dilated residual right ureter
(Figure 2).
Discussion
Renal agenesis is a fairly common congenital anomaly
with an unknown definite aetiology. Renal agenesis may
be unilateral or bilateral. BRA/D is a rare anomaly
incompatible with life, occurring in only one or two per
10 000 births. Despite it being a sporadic event, there is a
male-to-female ratio of 3:1 and approximately 20–36% of
BRA/D presents as familial recurrence. However, it is
rarely diagnosed antenatally because of the virtual
absence of the amniotic fluid.
Renal agenesis occurs when there is: (1) absence of the
metanephric blastema; (2) ureteral bud maldevelopment;
or (3) lack of induction of the metanephric blastema by
the ureteral bud. Sometimes solitary kidney is the result
of post-natal involution of multicystic dysplastic kidney
and hydronephrotic kidney.
Predictably, the ipsilateral ureter and hemitrigone also
fail to develop, although occasionally a blind-ending
ureteric stump may be present, as in our case. Ipsilateral
adrenal agenesis is seen in 8–10% of cases. Associated
ipsilateral urogenital anomalies are common and include
absence of the vas deferens, unicornuate uterus and
absence or cysts of the seminal vesicle, as seen in our
case. Other associated anomalies include skeletal
abnormalities, anorectal malformations, cryptorchism
and cardiovascular abnormalities. The classical associa-
tion is seen in the VATER syndrome where develop-
mental lesions may include vertebral and ventricular
septal anomalies, anorectal atresia, tracheal and oeso-
phageal lesions and radial bone abnormalities.

The British Journal of Radiology, August 2007 e167

 A Mishra

(a)

(b)

Figure 1. The ultrasound shows (a)

empty right renal fossa with com-
pensatory hypertrophy of the left
kidney with (b) associated blind-
ending right ureteric stump and (c)
hypoplastic cystic right seminal
(c) vesicle.

e168 The British Journal of Radiology, August 2007

Case report: Renal agenesis
Figure 2. CT urogram shows single kidney with single
ureter.
Unilateral renal agenesis is usually asymptomatic
when it occurs as an isolated anomaly.
The British Journal of Radiology, August 2007
Occasionally, unilateral renal agenesis can be diag-
nosed on plain film by the absence of a renal outline and
medial displacement of the colonic flexure into the renal
bed. The contralateral kidney, when normal, shows
compensatory hypertrophy and this may be visible on
the plain film.
However, these features are easier to see on ultra-
sound. Often it may be difficult to differentiate between
renal agenesis and a small atrophic kidney by
ultrasound.
CT or radionuclide investigation demonstrating uni-
lateral absence of renal tissue can be regarded as
definitive. Moreover, a CT scan, besides demonstrating
the absence of unilateral kidney, will also demonstrate
other associated abnormalities. With the advent of
multislice CT scans, a CT urogram can replace the
conventional urogram.
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3. Mesrobian HG, Rushton HG, Bulas D. Unilateral renal
agenesis may result from in utero regression of multicystic
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