Umbilical cord ulceration as a rare cause of neonatal acute kidney injury

The association of umbilical cord ulceration (UCU) and congenital upper intestinal (duodenal or jejunal) atresia has been reported since 1991. There have been multiple reports of life-threatening hemorrhage from UCU in patients with congenital upper intestinal atresia over the last two decades. However, there appears to be a gap in the dissemination of this knowledge.We report herein the case successfully treated with continuous hemodialysis in a neonate who presented acute kidney injury due to hemorrhage shock, and finally he was withdrawn from renal replacement therapy. In this case, renal tissue was also collected during surgery for congenital duodenal atresia. A kidney biopsy revealed severe>70% tubulointerstitial damage with glomerular immaturity. Acute renal injury due to UCU was found to be associated with circulatory failure. Although the prevention of sudden perinatal death is considered to be difficult, recognition of the clinical signs that typically precede hemorrhage and prepare the environment that can provide multidisciplinary care including renal replacement therapy may facilitate the early detection of this condition, thereby enabling the rescue of the affected fetuses. Further investigation is required to establish the management protocol.