 Hello everyone, my name is Ankita Singh and today I will be discussing two unique fetal renal anomalies through ultrasound diagnostics. USG is the primary modality for assessment of fetal urinary tract. It can be identified by approximately 10 weeks of gestation. The intricate development of kidneys during gestation plays a pivotal role in ensuring a healthy start to life. Kidneys continue to grow throughout pregnancy with the renal length remaining directly proportional to the gestational age. This paper will provide an overview on detection and analysis of two unique fetal renal anomalies. Fetal renal anomalies can affect amniotic fluid production, which can lead to oligo-hydromneas or anhydromneas resulting in pretern pulmonary hyperplasia and potentially abnormal development of other fetal structures. Analysis of sonomorphic evaluation includes the lack of ionizing radiation, the non-invasive nature of the examination and utility in pregnancy in which CT or MRI is contraindicated. As we know, renal anomalies are classified into number, which includes aeginesis supernumeric kidneys, position which includes ectopic or rotational abnormality, fusion which includes horseshoe kidney, crossed-fused ectopic kidney, structural abnormalities which includes lobulation, tissue mass, cystic diseases, mesoblastic nephroma and nephroblastomatosis. And the last is the renal vasculature pathologies. Out of these, we will be focusing on two important cases. Coming to the first case, a 27-year-old female came for anomaly scan with gestational age by LMP being 21 weeks 5 days. The scan shows two normally functioning kidneys positioned in either side of the midline showing horseshoe configuration with their lower poles being joined across the midline by renal tissue. However, there is no evidence of any abnormal renal pelvic or ureteric dilatation seen on either side. So in the image, we can see two isoacoic structures which is joining in the midline. We can also see the vertebral shadow. The joining is seen just anterior to the vertebral body. In the second image, we can see there is a parenchyma bridge in the midline. Here we can see the urinary bladder which is normal and we can also see the umbilical vessels on either side. On surgical view, we can see renal vessels arising from the aorta on either side that is each kidney is getting their individual blood supply. Renal anomalies may be a part of vectoral syndrome which needs to be ruled out. Vertebral syndrome consists of vertebral, anal, cardiac, tracheoesophageal, renal and limb anomalies. Prenatal diagnosis is based on ultrasound identification of these defects. In the image, we can see that the vertebral body shows normal alignment and curvature. There is no spinal anomalies seen, upper limb evaluation where we can see radius and allah, lower limb evaluation where we can see tibia and femur. There is presence of all the limbs and these show normal length. Coming to the cardiac evaluation, we can see left ventricular outflow tract and right ventricular outflow tract. In the second image, we can see three vessel tracheal view and actual view showing four chambers of heart. Therefore, no cardiac anomaly was present. To summarize, findings included single life fetus of 20 weeks, 6 days maturity which is appropriate for gestational age. Fetal kidneys show evidence of horseshoe configuration with otherwise no evidence of urinary tract dilatation seen. Urinary bladder is normal, lacquer is adequate and there was no other fetal anomaly detected. Few points about horseshoe kidney. Horsehoe kidney is the most common congenital anomaly of the upper urinary tract and can be found one in 400 adults. It is twice as common in men done in women. Horseshoe kidney is prone to recurrent urinary tract infection and stone formation. Coming to the second case, a 25 year old priming davida with unremarkable prenatal history reported for anti-natal anomaly USG. In the image, we can see urinary bladder was not demonstrable. Here we can see bilateral enlarged kidneys with increased ecogenicity compared to the surrounding structures with multiple tiny anechoic cysts within. There is reduced lycra as we can hardly see any cortary pocket. This is the actual view of bilateral kidneys in the second image. To summarize, findings include bilateral kidneys, diffusely enlarged anechogenic with multiple cysts within, oligohydromnias and non-visualized urinary bladder. So findings are likely suggestive of multi-cystic dysplastic kidney with absent urinary bladder and oligohydromnias. The diagnosis of multi-cystic dysplastic kidney is often made anti-natally with multiple cysts becoming evident as early as 15th week of gestation. Over time, appearances may change dramatically ranging from complete involution to large multi-cystic masses. Incidents is between 1 is 2000 and 1 is to 4,300 live births. This condition is more likely to cause pulmonary hypoplasia due to presence of oligohydromnias. Discussion Horseshoe kidney is frequently associated with other anomalies and chromosomal abnormalities such as ternosyndrome, trisomy 18, trisomy 9. Isolated Horseshoe kidney is a relatively benign disorder that requires postnatal urologic follow-up because of higher prevalence of vesicoeurotary reflux, renal calculi, urinary tract infection and hydronoprocess. Multi-cystic dysplastic kidney develops in utero. Diagnosis is often made either anti-natally or in the early neonatal period if an ultrasound is performed. It may otherwise go unrecognized and may be a common cause of renal agenesis following complete involution during childhood. Prenatal diagnosis of renal and urinary tract formation improves perinatal management and the prognosis of the affected chai. Objectives of prenatal USG is to describe the type of anomaly as accurately as possible to exclude associated malpomission and to screen for parameters predictive of bad renal function, allowing for a multinexciplinary perinatal approach. These are the references. I would like to express my sincere gratitude to my faculties, Dr. Om Tawri, Dr. Zomahar and Dr. Manil Manmohan for their invaluable contributions and support. Thank you.