The pre and postnatal appearance of the kidneys in Beckwith-Wiedemann Syndrome

The prenatal diagnosis of Beckwith-Wiedemann syndrome using ultrasound and magnetic resonance imaging

Beckwith-Wiedemann syndrome is a rare congenital overgrowth syndrome. It carries important connotations for the pediatric urologist because it is associated with an increased risk for developing certain embryonal tumors. Until recently, these patients were not diagnosed until after birth; however, with newer imaging modalities, this syndrome may be diagnosed prenatally. We present a case of Beckwith-Wiedemann syndrome, depicting the prenatal modalities that may be used to diagnose this unusual condition.

Prenatal diagnosis of Beckwith-Wiedemann syndrome

OBJECTIVES

The diagnosis of Beckwith-Wiedemann syndrome (BWS) typically is made after birth. To our knowledge, no established guidelines exist for the prenatal diagnosis of this condition. We present two new cases of prenatally diagnosed BWS and propose a diagnostic schema.

METHODS

Published reports obtained from Medline searches were reviewed and combined with our cases.

RESULTS

Our proposed schema of two major criteria (abdominal wall defect, macroglossia, macrosomia) or one major plus two minor criteria (nephromegaly/dysgenesis, adrenal cytomegaly, aneuploidy/abnormal loci, polyhydramnios) fits all published reports of prenatally diagnosed BWS.

CONCLUSION

The prenatal diagnosis of BWS can be reliably made by applying our proposed guidelines. This schema allows for uniform fetal diagnosis of the syndrome and helps prepare for prenatal counseling and peri- and post-natal management strategies.

Wiedemann-Beckwith syndrome

The Wiedemann-Beckwith syndrome (WBS) comprises an accumulation of multiple congenital anomalies. Exomphalos, macroglossia and gigantism are considered the most common manifestations, hence the alternative designation EMG-syndrome. The syndrome carries with it an increased risk of developing specific tumours. One of the more frequent metabolic changes is transient neonatal hypoglycaemia, the result of increased insulin secretion. Inheritance of the syndrome remains uncertain. Most cases are sporadic, but a number of familial cases have been reported. Present evidence suggests that WBS is an autosomal dominant trait with variable expressivity. This review summarizes the abundant literature on the subject and discusses recent molecular genetic developments that may explain the interrelationship between the clinical abnormalities, metabolic disturbances and development of tumours.

Antenatal diagnosis of urinary tract abnormalities: correlation of ultrasound appearance with postnatal diagnosis

A review was made of the natural history of the urinary tract abnormalities diagnosed antenatally in 18 fetuses in order to correlate the ultrasound appearance with subsequent postnatal diagnosis and prognosis. Unilateral disease, both obstruction and multicystic renal disease, was associated with a good prognosis. Bilateral dysplastic kidneys had a very poor prognosis. The antenatal ultrasound demonstration of bladder distention and/or hydronephrosis, however, does not always signify true obstruction of the urinary tract. This is important in view of the recent introduction of in utero interventions to preserve renal function and prevent pulmonary hypoplasia.