Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) are frequently associated with Mullerian anomalies. This can be explained by the fact that Mullerian duct elongation depends on the preformed Wolffian duct during embryogenesis. While CAKUT such as unilateral renal agenesis and multicystic dysplastic kidney are commonly identified prenatally by routine ultrasound, the diagnosis of Mullerian anomalies is often delayed, increasing the risk of complications such as endometriosis or pelvic inflammatory disease. Herein, we report a case of a premenarchal girl who had initially been diagnosed with right multicystic dysplastic kidney. She presented with continuous urinary incontinence at 4 years old and further evaluation by contrast-enhanced computed tomography, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to the final diagnosis of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus. A strong family history of uterine malformations prompted the examination of the uterus. Genetic testing was suggested but the family declined. She is planned to be referred to a gynecologist at puberty for further assessment. The recognition and screening rate of concurrent Mullerian anomalies in CAKUT patients varies between institutions. Screening for Mullerian anomalies in prediagnosed CAKUT girls may enable to provide timely counseling and to prevent gynecological complications.
Similar content being viewed by others
References
Santos XM, Dietrich JE. Obstructed hemivagina with ipsilateral renal anomaly. J Pediatr Adolesc Gynecol. 2016;29:7–10.
Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of mayer-rokitansky-küster-hauser (MRKH) syndrome. Clin Genet. 2017;91:233–46.
Kobayashi A, Kwan KM, Carroll TJ, McMahon AP, Mendelsohn CL, Behringer RR. Distinct and sequential tissue-specific activities of the LIM-class homeobox gene Lim1 for tubular morphogenesis during kidney development. Development. 2005;132:2809–23.
Chiga M, Ohmori T, Ohba T, Katabuchi H, Nishinakamura R. Preformed Wolffian duct regulates Müllerian duct elongation independently of canonical Wnt signaling or Lhx1 expression. Int J Dev Biol. 2014;58:663–8.
Carroll TJ, Park JS, Hayashi S, Majumdar A, McMahon AP. Wnt9b plays a central role in the regulation of mesenchymal to epithelial transitions underlying organogenesis of the mammalian urogenital system. Dev Cell. 2005;9(2):283–92.
Tan YG, Laksmi NK, Yap TL, Sadhana N, Ong CCP. Preventing the O in OHVIRA (obstructed hemivagina ipsilateral renal agenesis): early diagnosis and management of asymptomatic herlyn-werner-wunderlich syndrome. J Pediatr Surg. 2020;55:1377–80.
Friedman MA, Aguilar L, Heyward Q, Wheeler C, Caldamone A. Screening for Mullerian anomalies in patients with unilateral renal agenesis: leveraging early detection to prevent complications. J Pediatr Urol. 2018;14:144–9.
In’t Woud SG, Westland R, Feitz WFJ, Roeleveld N, van Wijk JAE, van der Zanden LFM, Schreuder MF. Clinical management of children with a congenital solitary functioning kidney: overview and recommendations. Eur Urol Open Sci. 2021;25:11–20.
Hains DS, Bates CM, Ingraham S, Schwaderer AL. Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol. 2009;24:233–41.
Collins DC. Congenital unilateral renal agenesia. Ann Surg. 1932;95:715–26.
O’Flynn O’Brien KL, Bhatia V, Homafar M, Gong YY, Winsten MT, Gerber J, Dietrich JE. The prevalence of Müllerian anomalies in women with a diagnosed renal anomaly. J Pediatr Adolesc Gynecol. 2021;34:154–60.
Capito C, Echaieb A, Lortat-Jacob S, Thibaud E, Sarnacki S, Nihoul-Fékété C. Pitfalls in the diagnosis and management of obstructive uterovaginal duplication: a series of 32 cases. Pediatrics. 2008;122:e891–7.
Clissold RL, Hamilton AJ, Hattersley AT, Ellard S, Bingham C. HNF1B-associated renal and extra-renal disease-an expanding clinical spectrum. Nat Rev Nephrol. 2015;11:102–12.
Faguer S, Chassaing N, Bandin F, Prouheze C, Garnier A, Casemayou A, Huart A, Schanstra JP, Calvas P, Decramer S, Chauveau D. The HNF1B score is a simple tool to select patients for HNF1B gene analysis. Kidney Int. 2014;86:1007–15.
Van Esch H, Groenen P, Nesbit MA, Schuffenhauer S, Lichtner P, Vanderlinden G, Harding B, Beetz R, Bilous RW, Holdaway I, Shaw NJ, Fryns JP, Van de Ven W, Thakker RV, Devriendt K. GATA3 haplo-insufficiency causes human HDR syndrome. Nature. 2000;406:419–22.
Hernández AM, Villamar M, Roselló L, Moreno-Pelayo MA, Moreno F, Del Castillo I. Novel mutation in the gene encoding the GATA3 transcription factor in a Spanish familial case of hypoparathyroidism, deafness, and renal dysplasia (HDR) syndrome with female genital tract malformations. Am J Med Genet A. 2007;143A:757–62.
Moldovan O, Carvalho R, Jorge Z, Medeira A. A new case of HDR syndrome with severe female genital tract malformation: comment on “novel mutation in the gene encoding the GATA3 transcription factor in a Spanish familial case of hypoparathyroidism, deafness, and renal dysplasia (HDR) syndrome with female genital tract malformations” by Hernández et al. Am J Med Genet A. 2011;155A:2329–30.
Van Esch H, Devriendt K. Transcription factor GATA3 and the human HDR syndrome. Cell Mol Life Sci. 2001;58:1296–300.
Grote D, Boualia SK, Souabni A, Merkel C, Chi X, Costantini F, Carroll T, Bouchard M. Gata3 acts downstream of beta-catenin signaling to prevent ectopic metanephric kidney induction. PLoS Genet. 2008;4: e1000316.
Biason-Lauber A, Konrad D, Navratil F, Schoenle EJ. A WNT4 mutation associated with Müllerian-duct regression and virilization in a 46 XX woman. N Engl J Med. 2004;351:792–8.
Vainio S, Heikkilä M, Kispert A, Chin N, McMahon AP. Female development in mammals is regulated by Wnt-4 signalling. Nature. 1999;397:405–9.
Stark K, Vainio S, Vassileva G, McMahon AP. Epithelial transformation of metanephric mesenchyme in the developing kidney regulated by Wnt-4. Nature. 1994;372:679–83.
Biason-Lauber A, De Filippo G, Konrad D, Scarano G, Nazzaro A, Schoenle EJ. WNT4 deficiency—a clinical phenotype distinct from the classic mayer-rokitansky-kuster-hauser syndrome: a case report. Hum Reprod. 2007;22:224–9.
Philibert P, Biason-Lauber A, Rouzier R, Pienkowski C, Paris F, Konrad D, Schoenle E, Sultan C. Identification and functional analysis of a new WNT4 gene mutation among 28 adolescent girls with primary amenorrhea and Müllerian duct abnormalities: a French collaborative study. J Clin Endocrinol Metab. 2008;93:895–900.
Philibert P, Biason-Lauber A, Gueorguieva I, Stuckens C, Pienkowski C, Lebon-Labich B, Paris F, Sultan C. Molecular analysis of WNT4 gene in four adolescent girls with Mullerian duct abnormality and hyperandrogenism (atypical mayer-rokitansky-küster-hauser syndrome). Fertil Steril. 2011;95:2683–6.
Mandel H, Shemer R, Borochowitz ZU, Okopnik M, Knopf C, Indelman M, Drugan A, Tiosano D, Gershoni-Baruch R, Choder M, Sprecher E. SERKAL syndrome: an autosomal-recessive disorder caused by a loss-of-function mutation in WNT4. Am J Hum Genet. 2008;82:39–47.
Acknowledgements
We gratefully acknowledge the hospital staff for their help and support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have declared that no conflict of interest exists.
Human and animal rights statement
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Informed consent was obtained from the patient’s parents.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Nakamura, M., Kanda, S., Kajiho, Y. et al. A case of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus in a prepubertal girl. CEN Case Rep 12, 122–129 (2023). https://doi.org/10.1007/s13730-022-00730-1
Received:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1007/s13730-022-00730-1