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Prenatal diagnosis of kidney disease has been greatly increased due to the improvement of antenatal ultrasound techniques, even if a level of uncertainty in differential diagnosis still leads to difficulties in the prediction of fetal outcome and in the counseling of parents. We have followed with ultrasound a 36-year-old secundigravida, referred for fetal renal ultrasound evaluation because of enlarged bilateral cystic kidneys and anhydramnios. Karyotype was normal (46,XY). On the 21 st  week, the kidneys were slightly enlarged with normal morphology. Beginning with the 28 th  week, repeated scans showed a reduction of amniotic fluid and an increasing number of renal cysts. Pregnancy was followed to the 37 th  week when fetal death occurred without warning. Postmortem gross examination showed bilateral enlarged kidneys and histology-defined diffuse mesangial sclerosis with poorly developed cortex and renal dysplasia with multiple cysts. This is an unusual case of multiple renal congenital abnormalities difficult to interpret and which made necessary a multidisciplinary approach due to its complexity. Nevertheless, etiology was not defined. The broad spectrum of antenatal manifestation of prenatally onset kidney diseases requires the identification of more prognostic signs to define fetal outcome and improve parental guidance.

Fetal death associated with diffuse mesangial sclerosis combined with bilateral multicystic kidney