Introduction:
Bilateral renal agenesis (BRA) is a rare yet particularly severe congenital anomaly, associated with high perinatal mortality. This narrative review aims to outline a holistic, family-centered care plan for neonates with BRA.

Methods:
This narrative review was based on case reports, qualitative studies, narrative and scoping reviews, concept analyses, expert opinion studies and good practice recommendations, retrospective studies, clinical trials, as well as presentations of theoretical models. Sources were identified through searches in electronic databases such as PubMed, Google Scholar, and EBSCO, including publications in English and Greek from 1994 to 2025, using MeSH terms. Data selection and extraction were performed independently by three authors, with disagreements resolved through discussion with a fourth author. No formal quality assessment of the studies was conducted.

Results:
Analysis of the studies revealed six key thematic axes in the care of neonates with BRA: (1) the possibilities and limitations of medical intervention, (2) active parental involvement in decision-making, (3) addressing psychological, emotional, and social needs, (4) individualized support based on values and cultural particularities, (5) integration of palliative care principles, and (6) promotion of a human-centered approach to care.

Conclusions:
Effective management of BRA requires an interdisciplinary approach that combines scientific excellence with ethical and empathy. The integration of family-centered, culturally sensitive, and palliative practices emerges as a necessary condition for providing holistic and human-centered care in contexts of clinical uncertainty.