Adult Diagnosis of Solitary Kidney and Renal Dysplasia in a Male Born Prematurely as a Twin: A Case Report.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of chronic renal disease and usually manifest either antenatally or in the early years of life. Solitary Kidney with Renal Dysplasia presents early in life due to regular antenatal sonographic scans. The rarity of diagnosis being deferred until adulthood has important implications when there is prematurity and other associated congenital anomalies, such as Congenital Heart Disease. Case Presentation: We present a 23-year-old male experiencing sequential generalized edematous changes, decreased urine output, early feelings of fullness during meals, and vomiting following the intake of a meal for the last month. The patient was born prematurely at approximately seven months of gestation, and he was a twin, with the loss of the co-twin soon after birth. There was neither a previous chronic disease nor hospitalization. Physical evaluation showed the patient to be hypertensive with generalized edematous changes of the face and both lower limbs, along with systolic murmurs at the lower edge of the left sternal region. Laboratory findings indicated the presence of severe renal impairment with high serum creatinine and potassium, massive proteinuria, and severe anemia. Renal ultrasound revealed a small, echogenic right kidney compatible with chronic renal disease and an absent left kidney, confirming the suspicion of a solitary right dysplastic kidney. The cardiac study showed dilated cardiac chambers with an atrial septal defect, mild pericardial effusion, and the patient was placed on antihypertensive drugs and diuretics and started on hemodialysis. Conclusion: This is a rare adult presentation of solitary kidney and renal dysplasia in a prematurely born male twin, further compounded by atrial septal defect and end-stage renal disease. This report underscores the significant implications of these complications as a direct sequel to prematurity regarding the associated severe consequences for the subsequent renal and cardiovascular systems of these patients. Antenatal ultrasound scans play a crucial role in the early detection and management of such abnormalities.