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Yavuz S, Kıyak A, Sander S. Outcome of children with multicystic dysplastic kidney: Does involved side matter? Birth Defects Res 2024; 116:e2297. [PMID: 38158777 DOI: 10.1002/bdr2.2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Multicystic dysplastic kidney (MCDK) is a common anomaly detected on antenatal ultrasound. We aimed to assess the profile of children with MCDK and to investigate whether the involved side has any effect on outcome. METHODS Thirty-nine patients with MCDK and 20 controls were enrolled. Patients who estimated glomerular filtration rate (eGFR) values over 90 mL/min/1.73 m2 were compared with controls. Comparison was made between the involved sides. RESULTS MKDB was right-sided in 20 (51.3%) and left-sided in 19 (48.7%) patients. 33.3% had additional urinary tract abnormality, 10.2% had systemic abnormality. 82% showed contralateral kidney enlargement. 48.7% involuted, 17.9% underwent nephrectomy. 35.8% suffered from urinary tract infection (UTI). 5.1% had renal scarring (RS). 30% developed microalbuminuria. 12.8% complicated with hypertension. 17.9% progressed to chronic kidney disease (CKD). Hypertension was independent risk factor for developing CKD. Blood pressure, cystatin C and urine microalbumin/creatinine levels were increased, and eGFR values were decreased in patients compared to controls. No significant difference was found between the two sides for rates of involution, UTI, RS, nephrectomy, and additional abnormality. Cystatin C levels were higher on the right than left sides (p = .033). CONCLUSION Children with MCDK predispose to renal deterioration even at normal eGFR values. Although cystatin C levels tended to increase in right-sided patients, the involved side seemed to have no significant effect on renal outcome. Hypertension was main determinant for progression to CKD in MCDK.
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Affiliation(s)
- Sevgi Yavuz
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Aysel Kıyak
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Serdar Sander
- Division of Pediatric Urology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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La Scola C, Ammenti A, Bertulli C, Bodria M, Brugnara M, Camilla R, Capone V, Casadio L, Chimenz R, Conte ML, Conversano E, Corrado C, Guarino S, Luongo I, Marsciani M, Marzuillo P, Meneghesso D, Pennesi M, Pugliese F, Pusceddu S, Ravaioli E, Taroni F, Vergine G, Peruzzi L, Montini G. Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology. Pediatr Nephrol 2022; 37:2185-2207. [PMID: 35713730 PMCID: PMC9307550 DOI: 10.1007/s00467-022-05528-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), with controversial results, and a worldwide consensus on management and follow-up is lacking. In this consensus statement, the Italian Society of Pediatric Nephrology summarizes the current knowledge on CSK and presents recommendations for its management, including diagnostic approach, nutritional and lifestyle habits, and follow-up. We recommend that any antenatal suspicion/diagnosis of CSK be confirmed by neonatal ultrasound (US), avoiding the routine use of further imaging if no other anomalies of kidney/urinary tract are detected. A CSK without additional abnormalities is expected to undergo compensatory enlargement, which should be assessed by US. We recommend that urinalysis, but not blood tests or genetic analysis, be routinely performed at diagnosis in infants and children showing compensatory enlargement of the CSK. Extrarenal malformations should be searched for, particularly genital tract malformations in females. An excessive protein and salt intake should be avoided, while sport participation should not be restricted. We recommend a lifelong follow-up, which should be tailored on risk stratification, as follows: low risk: CSK with compensatory enlargement, medium risk: CSK without compensatory enlargement and/or additional CAKUT, and high risk: decreased GFR and/or proteinuria, and/or hypertension. We recommend that in children at low-risk periodic US, urinalysis and BP measurement be performed; in those at medium risk, we recommend that serum creatinine also be measured; in high-risk children, the schedule has to be tailored according to kidney function and clinical data.
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Affiliation(s)
- Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Anita Ammenti
- Pediatric Multi-Specialistic Unit, Poliambulatorio Medi-Saluser, Parma, Italy
| | - Cristina Bertulli
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Monica Bodria
- Division of Nephrology, Dialysis, Transplantation, and Laboratory On Pathophysiology of Uremia, Istituto G. Gaslini, Genova, Italy
| | | | - Roberta Camilla
- Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca' Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Luca Casadio
- Unità Operativa Complessa Di Pediatria E Neonatologia, Ospedale Di Ravenna, AUSL Romagna, Ravenna, Italy
| | - Roberto Chimenz
- Unità Operativa Di Nefrologia Pediatrica Con Dialisi, Azienda Ospedaliero-Universitaria G. Martino, Messina, Italy
| | - Maria L Conte
- Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Ester Conversano
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Ciro Corrado
- Pediatric Nephrology, "G. Di Cristina" Hospital, Palermo, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli, Napoli, Italy
| | - Ilaria Luongo
- Unità Operativa Complessa Di Nefrologia E Dialisi, AORN Santobono - Pausilipon, Napoli, Italy
| | - Martino Marsciani
- Unità Operativa Di Pediatria E Terapia Intensiva Neonatale-Pediatrica, Ospedale M Bufalini, Cesena, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli, Napoli, Italy
| | - Davide Meneghesso
- Unità Operativa Complessa Di Nefrologia Pediatrica - Dialisi E Trapianto, Dipartimento Di Salute Della Donna E del Bambino, Azienda Ospedaliero-Universitaria Di Padova, Padova, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabrizio Pugliese
- Pediatric Nephrology Unit, Department of Pediatrics, Marche Polytechnic University, Ancona, Italy
| | | | - Elisa Ravaioli
- Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca' Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | | | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca' Granda IRCCS, Policlinico Di Milano, Milano, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Hannallah A, Baker ZG, De Filippo RE, Sparks SS, Ko J, Vasquez E. Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:854-861. [PMID: 35246854 DOI: 10.1002/jcu.23172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare the prevalence of vesicoureteral reflux (VUR), febrile urinary tract infection (fUTI), and chronic kidney disease (CKD) among patients with multicystic dysplastic kidney (MCDK) diagnosed by renal scintigraphy (RS) versus follow-up renal ultrasound (RUS) alone. METHODS This was a retrospective review of patients seen at a tertiary care center from 2010 to 2020 with MCDK diagnosed by RS or follow-up RUS. Differences in the prevalence of VUR, fUTI, and CKD by cohort were assessed using logistic regression analysis, Pearson X2 , and Fisher's Exact tests. Temporal trends in diagnostic methods used (RUS versus RUS + RS) were evaluated using the Cochran-Armitage trend test. RESULTS One-hundred seventy-two patients were included: 50% (n = 86) underwent RUS + RS and 50% (n = 86) underwent RUS alone to diagnose MCDK. Prevalence of VUR, fUTI, and CKD did not significantly vary between groups. Among patients who had a VCUG, 4.4% had contralateral VUR (1.7% RUS + RS group; 7.4% RUS group; p = 0.19) and 14.5% had at least one fUTI (16.3% RUS + RS group; 12.8% RUS group; p = 0.52). Females were significantly more likely to have at least one fUTI (p = 0.04). Four patients (2.3%) developed CKD, all in the RUS + RS cohort (p = 0.12). Diagnosis of MCDK by RUS versus RUS + RS did not significantly vary over time (p = 0.17). CONCLUSION Patients with unilateral MCDK confirmed by RS versus RUS alone do not significantly vary in the prevalence of VUR, fUTI, or CKD. Renal scintigraphy studies may not be necessary in unilateral MCDK diagnosis but continue to be used.
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Affiliation(s)
- Arthi Hannallah
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Zoë G Baker
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Roger E De Filippo
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - S Scott Sparks
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Joan Ko
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Evalynn Vasquez
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, USA
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Kohl S, Avni FE, Boor P, Capone V, Clapp WL, De Palma D, Harris T, Heidet L, Hilger AC, Liapis H, Lilien M, Manzoni G, Montini G, Negrisolo S, Pierrat MJ, Raes A, Reutter H, Schreuder MF, Weber S, Winyard PJD, Woolf AS, Schaefer F, Liebau MC. Definition, diagnosis and clinical management of non-obstructive kidney dysplasia: a consensus statement by the ERKNet Working Group on Kidney Malformations. Nephrol Dial Transplant 2022; 37:2351-2362. [PMID: 35772019 PMCID: PMC9681917 DOI: 10.1093/ndt/gfac207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/31/2022] Open
Abstract
Kidney dysplasia is one of the most frequent causes of chronic kidney failure in children. While dysplasia is a histological diagnosis, the term 'kidney dysplasia' is frequently used in daily clinical life without histopathological confirmation. Clinical parameters of kidney dysplasia have not been clearly defined, leading to imprecise communication amongst healthcare professionals and patients. This lack of consensus hampers precise disease understanding and the development of specific therapies. Based on a structured literature search, we here suggest a common basis for clinical, imaging, genetic, pathological and basic science aspects of non-obstructive kidney dysplasia associated with functional kidney impairment. We propose to accept hallmark sonographic findings as surrogate parameters defining a clinical diagnosis of dysplastic kidneys. We suggest differentiated clinical follow-up plans for children with kidney dysplasia and summarize established monogenic causes for non-obstructive kidney dysplasia. Finally, we point out and discuss research gaps in the field.
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Affiliation(s)
- Stefan Kohl
- Department of Pediatrics, University Hospital of Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Fred E Avni
- Department of Pediatric Imaging, Jeanne de Flandre Hospital, Lille University Hospitals, Lille Cedex, France
| | - Peter Boor
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany,Medical Clinic II (Nephrology and Immunology), University Hospital RWTH Aachen, Aachen, Germany
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - William L Clapp
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Diego De Palma
- Nuclear Medicine Unit, Circolo Hospital and Macchi Foundation, ASST-settelaghi, Varese, Italy
| | - Tess Harris
- The Polycystic Kidney Disease Charity, London, UK
| | - Laurence Heidet
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France,APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital universitaire Necker-Enfants malades, Paris, France
| | - Alina C Hilger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany,Research Center On Rare Kidney Diseases (RECORD), University Hospital Erlangen, Erlangen, Germany
| | - Helen Liapis
- Nephrology Center, Ludwig Maximilian University (LMU), Munich, Germany
| | - Marc Lilien
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Susanna Negrisolo
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Marie-Jeanne Pierrat
- Federation of European Patient Groups affected by Rare/Genetic Kidney Diseases (FEDERG), Brussels, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Heiko Reutter
- Research Center On Rare Kidney Diseases (RECORD), University Hospital Erlangen, Erlangen, Germany,Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatric and Adolescent Medicine, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Stefanie Weber
- Department of Pediatric Nephrology, Marburg Kidney Research Center, Philipps University, Marburg, Germany
| | - Paul J D Winyard
- University College London Great Ormond Street, Institute of Child Health, London, UK
| | - Adrian S Woolf
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK,Royal Manchester Children's Hospital, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Guarino S, Di Sessa A, Riccio S, Capalbo D, Reginelli A, Cappabianca S, Rambaldi PF, Miraglia del Giudice E, Polito C, Marzuillo P. Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information. J Clin Med 2022; 11:1052. [PMID: 35207325 PMCID: PMC8876569 DOI: 10.3390/jcm11041052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to evaluate the prognostic value of renal length (RL) > 2 standard deviation scores (SDS) measured by renal ultrasound (RUS), across infancy, childhood and adolescence, in identifying which patients with congenital solitary functioning kidney (CSFK) are at lower risk of developing kidney injury (KI). We also estimated the cost saving of integrating the current follow-up protocols with an early RUS algorithm (ERUSA). Fifty-six CSFK adult patients who were 1-3 months old at first observation of undergoing RUS were enrolled. KI was defined by hypertension and/or proteinuria and/or declined renal function. ERUSA was assessed by early (at 1-3 months of life) RUS and was retrospectively tested in our patients. ERUSA establishes that patients with RL > 2SDS at early RUS do not undergo further follow-ups. The others undergo another RUS at 1 year of age along with follow-ups according with current protocols, with the exception of RUS which could be no longer performed. Direct and indirect costs were calculated for each analysed protocol and the cost saving of applying ERUSA was calculated. None of the patients with early RL > 2SDS presented KI in adulthood. A RL > 2SDS was predictive of absence of KI only at 1-3 months (OR = infinity) and 1 year of age (OR = 0.13; 95%CI: 0.03-0.66; p = 0.01). ERUSA provided a total cost-sparing ranging from 38.6% to 55.3% among the analysed follow-up protocols. With ERUSA, no patients developing KI in adulthood were missed. In conclusion, only a RL > 2SDS at 1-3 months and 1 year of age predicted good prognosis in young adulthood. ERUSA can guide a cost-sparing follow-up strategy in CSFK patients while maintaining important long-term information.
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Affiliation(s)
- Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Simona Riccio
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Daniela Capalbo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Alfonso Reginelli
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.R.); (S.C.)
| | - Pier Francesco Rambaldi
- Nuclear Medicine, Department of Radiological Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Cesare Polito
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy; (S.G.); (A.D.S.); (S.R.); (D.C.); (E.M.d.G.); (C.P.)
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Outcomes of solitary functioning kidneys-renal agenesis is different than multicystic dysplastic kidney disease. Pediatr Nephrol 2021; 36:3673-3680. [PMID: 33954810 DOI: 10.1007/s00467-021-05064-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multicystic dysplastic kidney (MCDK) disease and unilateral renal agenesis (URA) are well-known causes of a solitary functioning kidney (SFK) and are associated with long-term kidney injury. The aims of this study were to characterize the natural history of SFK at our center, define the risk factors associated with chronic kidney injury, and identify distinguishing features between URA and MCDK that predict outcome. METHODS This was a retrospective cohort study of 230 SFK patients. We compared MCDK (n=160) and URA (n=70) according to clinical features at diagnosis and kidney outcomes over follow-up. Univariate and multivariate binary regression analysis was used to determine independent risk factors for chronic kidney injury, defined as the composite outcome of hypertension, proteinuria, or chronic kidney disease (eGFR <60 mL/min/1.73m2). RESULTS URA had a higher prevalence of comorbid genetic syndromes (15 vs. 6%, p=0.04), non-renal anomalies (39 vs. 11%, p<0.001), and congenital anomalies of the kidney and urinary tract (CAKUT) (51 vs. 26%, p<0.001) than MCDK. Over follow-up, URA experienced more hypertension (19 vs. 3%, p=0.002), proteinuria (12 vs. 3%, p=0.03), and the composite outcome (19 vs. 6%, p=0.003) than MCDK. Independent risk factors for chronic kidney injury included CAKUT (OR 5.01, p=0.002) and URA (OR 2.71, p=0.04). CONCLUSIONS In our population, URA was more likely to have associated syndromes or anomalies, and to have worse outcomes over time than MCDK. URA diagnosis was an independent risk factor for chronic kidney injury. Our results will be used to develop a standardized clinical pathway for SFK management. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Gilad N, Weissmann-Brenner A, Gilboa Y, Dekel B, Achiron R, Perlman S. Multicystic Dysplastic Kidney: Prenatal Compensatory Renal Growth Pattern. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2165-2171. [PMID: 33351224 DOI: 10.1002/jum.15605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To assess the prenatal growth pattern of the normal kidney contralateral to a multicystic dysplastic kidney (MCDK). METHODS A retrospective study was conducted in a single referral center over 4 years. Cases diagnosed prenatally as MCDK and confirmed postnatally constituted the study group. For creation of nomograms, only isolated cases of MCDK were included. RESULTS Sixty-one fetuses had a diagnosis of an MCDK during the study period. After exclusion of cases with associated malformations, 47 fetuses remained, providing 94 measurements for creation of nomograms. The growth pattern of the normal kidney contralateral to an MCDK was linear throughout gestation (percentile = 20.01 + 1.5 gestational age; linear R2 = 0.753; r = 0.868) and was significantly higher during the third trimester (29-38 weeks' gestation) compared to the second trimester (22-28 weeks' gestation; P < .001). A comparison of the growth pattern of the normal kidney contralateral to the MCDK to the growth pattern of a solitary kidney revealed a significant higher compensatory trend during the third trimester (P < .0001). The mean kidney lengths at 22 and 38 weeks' gestation correlated with the 52nd and 88th and with the 84th and 90th percentiles for the normal kidney contralateral to the MCDK and a solitary kidney, respectively. CONCLUSIONS According to our study, the normal kidney contralateral to an MCDK has a unique growth pattern during intrauterine life, with dominant growth during the third trimester. The exact mechanism for this pattern, in comparison to early renal hypertrophy shown in solitary kidneys, is currently not clear. These data provide relevant information for the multidisciplinary prenatal counseling of future parents regarding the future renal outcome.
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Affiliation(s)
- Noa Gilad
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Yinon Gilboa
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Benjamin Dekel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
- Division of Pediatric Nephrology and Pediatric Stem Cell Research Institute, Edmond and Lily Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Sharon Perlman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
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8
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Jawa NA, Rosenblum ND, Radhakrishnan S, Pearl RJ, Levin L, Matsuda-Abedini M. Reducing Unnecessary Imaging in Children With Multicystic Dysplastic Kidney or Solitary Kidney. Pediatrics 2021; 148:peds.2020-035550. [PMID: 34230093 DOI: 10.1542/peds.2020-035550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with isolated unilateral multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK) undergo serial renal ultrasonography with variable frequency until they are transitioned to adult care. A growing body of literature suggests the value of frequent ultrasonography in this population is limited, providing no benefit to overall outcomes. Despite emerging evidence, ultrasound remains overused, resulting in avoidable health care expenditures and unnecessary use of resources. With our initiative, we aimed to improve quality of care by reducing avoidable ultrasounds in these children. METHODS This was a single-center, prospective, interrupted time series of children <18 years with ultrasound-confirmed isolated unilateral MCDK or CSK in the outpatient nephrology clinic to evaluate the effect of a decision-making algorithm on the proportion of children receiving an avoidable ultrasound. An algorithm depicting a consensus, evidence-based protocol for managing pediatric MCDK or CSK was refined through content expert feedback and usability testing to standardize frequency of ultrasonography. Ultrasounds were deemed necessary after birth, at 6 months, and at 2, 5, 10, and 15 years. Differences pre- and postintervention were determined by using a U chart and t and F tests for significance. RESULTS The algorithm resulted in a 47% reduction (P < .001) in the proportion of avoidable ultrasounds ordered in children with MCDK and CSK. This reduction was sustainable over a 6-month period and would result in at least $46 000 annual savings. CONCLUSIONS Introduction of a clinical decision-making algorithm was associated with a reduction in avoidable ultrasound testing. Improving adherence across providers may allow for an even more pronounced reduction.
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Affiliation(s)
- Natasha A Jawa
- Division of Nephrology and .,Department of Pediatrics, Faculty of Medicine
| | - Norman D Rosenblum
- Division of Nephrology and.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Seetha Radhakrishnan
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel J Pearl
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leo Levin
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mina Matsuda-Abedini
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Hutchinson KA, Halili L, Guerra A, Geier P, Keays M, Guerra L. Renal function in children with a congenital solitary functioning kidney: A systematic review. J Pediatr Urol 2021; 17:556-565. [PMID: 33752977 DOI: 10.1016/j.jpurol.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Abnormal renal development that results in lack of function or development of one of two kidneys is known as congenital solitary functioning kidney (CSFK). Two well characterized sub-categories of CFSK are unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK). This systematic review sought to evaluate the change in renal function in children ≤18 years old with a CSFK as a result of URA or MCDK. METHODS A literature search in MEDLINE and Embase was conducted (1946 to July 13, 2020). All relevant articles were retrieved and evaluated based on pre-selected criteria by two independent researchers. Data was then extracted from variables of interest and conflicts were resolved by a third researcher. The primary outcome was renal function, and the secondary outcomes were proteinuria and hypertension. RESULTS Forty-five studies were included, of which 49% (n = 22) were retrospective and/or 58% (n = 26) were cohort studies. A combined total of 2148 and 885 patients were diagnosed with MCDK or URA, respectively. The proportion of children with worsened renal function at follow-up was found to be 8.4% (95% CI: 5.2%-13.4%). Among the studies reporting renal function as a group mean or median at follow-up, 84% (21/25) had a GFR/CrCl above 90 (mL/min/1.73 m2/ml/min). In terms of secondary outcomes, the proportion of children with proteinuria and hypertension was found to be 10.1% (95% CI: 6.9%-14.6%) and 7.4% (95% CI: 5.0%-10.9%), respectively. CONCLUSION The risk of developing proteinuria (10.1%), hypertension (7.4%), and/or worsened renal function (8.4%) for children with CFSK as a result of MCDK or URA is low. However, the level of evidence in the literature is weak. Further research is needed to identify the predisposing factors that may differentiate the small subset of children with CSFK at a higher risk of developing adverse renal outcomes.
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Affiliation(s)
- Kelly Ann Hutchinson
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Lyra Halili
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Andre Guerra
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada
| | - Pavel Geier
- Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Melise Keays
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luis Guerra
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
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10
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Marzuillo P, Guarino S, Ursi D, Di Sessa A, Rambaldi PF, La Manna A, Miraglia Del Giudice E, Polito C. Early Renal Ultrasound in Congenital Solitary Kidney May Help to Select Patients at Lower Risk of Associated Vesicoureteral Reflux. Neonatology 2021; 118:482-486. [PMID: 34148042 DOI: 10.1159/000516694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vesicoureteral reflux (VUR) may be associated with renal dysplasia and reduced renal length (RL). The diagnosis of VUR in children with congenital solitary functioning kidney (CSFK) identifies patients at risk of kidney injury but exposes to invasive procedures. OBJECTIVE We aimed to test the hypothesis that an RL >2 standard deviation score (SDS) in the first months of life - reflecting renal hyperplasia - could identify CSFK patients with lower probability of presenting VUR. METHOD We retrospectively selected 207 CSFK patients with prenatal diagnosis of CSFK and having undergone renal ultrasound (RUS) both at 0-3 and 10-13 months of life, renal scintigraphy, and cystourethrography/cysto-scintigraphy. We compared the cumulative proportion of an RL >2 SDS by Kaplan-Meier analysis and evaluated the odds to present VUR of patients with an RL >2 SDS both at the first and second RUS. RESULTS Overall, 3.3% of patients with VUR and 22.0% of patients without VUR presented an RL >2 SDS at the first RUS (p = 0.02). At the second RUS, 53.3% of patients with VUR and 52.5% of patients without VUR presented an RL >2 SDS (p = 0.93). Patients without VUR presented higher cumulative proportion of an RL >2 SDS at 3 months of life than those with VUR (p = 0.02). This difference however disappeared at 11 and 13 months of age (p = 0.17 and p = 0.54, respectively). An RL >2 SDS within 3 months of life presented an OR for VUR of 0.12 (95% CI: 0.02-0.92; p = 0.005), while an RL >2 SDS at 12 months of life presented an OR for VUR of 0.96 (95% CI: 0.45-2.1; p = 0.93). CONCLUSION Only an RUS made in the first months of life could identify CSFK patients at lower risk of presenting an associated VUR.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Ursi
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pier Francesco Rambaldi
- Department of Radiological Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Cesare Polito
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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11
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Irfan A, O'Hare E, Jelin E. Fetal interventions for congenital renal anomalies. Transl Pediatr 2021; 10:1506-1517. [PMID: 34189109 PMCID: PMC8192995 DOI: 10.21037/tp-2020-fs-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congenital abnormalities of the kidney and urinary tract (CAKUT) represent 20% of prenatally diagnosed congenital abnormalities. Although the majority of these abnormalities do not require intervention either pre or postnatally, there is a subset of patients whose disease is so severe that it may warrant intervention prior to delivery to prevent morbidity and mortality. These cases consist of patients with moderate lower urinary tract obstruction (LUTO) in which vesicocentesis, shunting or cystoscopy are options and patients with early pregnancy renal anhydramnios (EPRA) in whom amnioinfusion therapy may be an option. The main causes of EPRA are congenital bilateral renal agenesis (CoBRA), cystic kidney disease (CKD) and severe LUTO. Untreated, EPRA is universally fatal secondary to anhydramnios induced pulmonary hypoplasia. The evidence regarding therapy for LUTO is limited and the stopped early PLUTO (Percutaneous Shunting in Lower Urinary Tract Obstruction) trial was unable to provide definitive answers about patient selection. Evidence for EPRA therapy is also scant. Serial amnioinfusions have shown promise in cases of EPRA due to CoBRA or renal failure and this treatment modality forms the basis of the ongoing NIH funded RAFT (Renal Anhydramnios Fetal Therapy) trial. At present, there is consensus that treatment for EPRA should only occur in the setting of a clinical trial.
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Affiliation(s)
- Ahmer Irfan
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth O'Hare
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric Jelin
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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12
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Sugimoto K, Enya T, Joh K, Miyazaki K, Miyazawa T, Ohshima R, Marutani S, Tsukasa T, Okada M. Pathophysiological clinical features of an infant with hypertension secondary to multicystic dysplastic kidney: a case report. BMC Nephrol 2021; 22:55. [PMID: 33546619 PMCID: PMC7866690 DOI: 10.1186/s12882-021-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of hypertension with congenital renal hypoplasia has been established. We report a case of an infant who underwent nephrectomy for hypertension. CASE PRESENTATION Magnetic resonance imaging for the mother revealed fetal renal masses, and fetal multicystic dysplastic kidney was suspected. Following birth, the baby developed hypertension. Numerous investigations revealed that the left kidney was non-functional, and she was initiated on benazepril hydrochloride. However, because the drug response was poor, the left kidney was removed at the age of 7 months. Examination of the renal specimen revealed abrupt transition from normal to atrophic cortex with lobar atrophy and cysts. Tubular atrophy, marked abnormal blood vessels with wall thickening, gathered immature glomeruli, and parenchymal destruction were observed. Renin was partially localized in the proximal tubules and the parietal epithelium of the Bowman's capsule in the immature glomeruli. We speculated that an abnormal vascular structure and irregular renin localizations may be the cause of hypertension. Serum renin and aldosterone levels gradually reduced post-surgery, reaching normal levels on the 90th postoperative day. A long follow-up is needed due to the possibility of the child developing hypertension in the future. CONCLUSION This is a case of an infant with MCDK, which discusses the clinicopathological features based on the pathophysiological analysis, including renin evaluation.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan.
| | - Takuji Enya
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Kensuke Joh
- Department of Pathology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kohei Miyazaki
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Tomoki Miyazawa
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Rina Ohshima
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Satoshi Marutani
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Takemura Tsukasa
- Department of Pediatrics, Kushimoto Municipality Hospital, Higashimuro-gun, Wakayama, Japan
| | - Mitsuru Okada
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
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13
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Jelin AC, Sagaser KG, Forster KR, Ibekwe T, Norton ME, Jelin EB. Etiology and management of early pregnancy renal anhydramnios: Is there a place for serial amnioinfusions? Prenat Diagn 2020; 40:528-537. [PMID: 32003482 DOI: 10.1002/pd.5658] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/11/2022]
Abstract
Early pregnancy renal anhydramios (EPRA) comprises congenital renal disease that results in fetal anhydramnios by 22 weeks of gestation. It occurs in over 1 in 2000 pregnancies and affects 1500 families in the US annually. EPRA was historically considered universally fatal due to associated pulmonary hypoplasia and neonatal respiratory failure. There are several etiologies of fetal renal failure that result in EPRA including bilateral renal agenesis, cystic kidney disease, and lower urinary tract obstruction. Appropriate sonographic evaluation is required to arrive at the appropriate urogenital diagnosis and to identify additional anomalies that allude to a specific genetic diagnosis. Genetic evaluation variably includes karyotype, microarray, targeted gene testing, panels, or whole exome sequencing depending on presentation. Patients receiving a fetal diagnosis of EPRA should be offered management options of pregnancy termination or perinatal palliative care, with the option of serial amnioinfusion therapy offered on a research basis. Preliminary data from case reports demonstrate an association between serial amnioinfusion therapy and short-term postnatal survival of EPRA, with excellent respiratory function in the neonatal period. A multicenter trial, the renal anhydramnios fetal therapy (RAFT) trial, is underway. We sought to review the initial diagnosis ultrasound findings, genetic etiologies, and current management options for EPRA.
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Affiliation(s)
- Angie C Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland.,The McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Katelynn G Sagaser
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Katherine R Forster
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Tochi Ibekwe
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mary E Norton
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Eric B Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland.,Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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14
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Chang A, Sivananthan D, Nataraja RM, Johnstone L, Webb N, Lopez PJ. Evidence-based treatment of multicystic dysplastic kidney: a systematic review. J Pediatr Urol 2018; 14:510-519. [PMID: 30396841 DOI: 10.1016/j.jpurol.2018.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES There is a lack of a standardised protocol for the investigation and non-operative management of paediatric multicystic dysplastic kidney (MCDK). Institutional protocols for non-operative management remain essentially ad hoc. The primary outcome of this systematic review is to establish the incidence of hypertension associated with an MCDK. The secondary outcome is to determine the malignancy risk associated with an MCDK. The tertiary outcome is to assess the rate of MCDK involution. Subsequent to these, an evidence-based algorithm for follow-up is described. METHODOLOGY A systematic review of all relevant studies published between 1968 and April 2017 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified by specific inclusion and exclusion criteria, all of which included data relevant to the primary, secondary and tertiary outcomes. Hypertension was defined as systolic blood pressure greater than the 95th centile for gender, age and height centile. Subset analysis was performed for hypertension associated with an MCDK. RESULTS The primary outcome measure revealed a 3.2% (27/838) risk of developing hypertension associated with an MCDK. The secondary outcome measure noted a 0.07% malignancy risk (2/2820). The tertiary outcome measure established that 53.3% (1502/2820) had evidence of involution of the dysplastic kidney. A total of 44 cohort studies (2820 patients) were analysed. CONCLUSION Given the low risk of hypertension and malignancy, which is similar to the general population, the current conservative non-operative pathway is an appropriate management strategy. An algorithm to help support clinicians with ongoing management is proposed.
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Affiliation(s)
- A Chang
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia
| | - D Sivananthan
- Department of Paediatric Nephrology, Monash Children's Hospital, Melbourne, Australia
| | - R M Nataraja
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - L Johnstone
- Department of Paediatric Nephrology, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - N Webb
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia
| | - P-J Lopez
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia; Department of Urology, Hospital Exequiel Gonzalez Cortes, Santiago, Chile; Clinica Alemana, Santiago, Chile.
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15
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Kara A, Gurgoze MK, Aydin M, Koc ZP. Clinical features of children with multicystic dysplastic kidney. Pediatr Int 2018; 60:750-754. [PMID: 29856512 DOI: 10.1111/ped.13612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the clinical features of patients with multicystic dysplastic kidney (MCDK). METHODS The medical files of children diagnosed with MCDK between January 2008 and November 2015 were retrospectively reviewed. The demographic, clinical, laboratory and radiological data were evaluated. RESULTS Of 128 children with MCDK enrolled in the study, 82 (64.1%) were male, and 46 (35.9%) were female (P < 0.05). MCDK were located on left and right sides in 66 (51.6%) and 62 children (48.4%), respectively (P > 0.05). Antenatal diagnosis was present in 64 patients (50%). The mean age at diagnosis was 2.8 ± 2.7 years (range, 0-8 years), and follow-up duration was 4.5 years. Fifteen patients (20.8%) had vesicoureteral reflux. Of these, four underwent endoscopic surgical correction. Other associated urological anomalies were ureteropelvic junction obstruction (n = 6), hypospadias (n = 1), and kidney stones (n = 1). On technetium-99 m dimercaptosuccinic acid scintigraphy, which was performed in all patients, no significant association between grade of reflux and presence of scarring was seen. Hypertension was diagnosed only in one child (0.8%) who required antihypertensive treatment. The prevalence of unilateral undescended testicle in children aged <1 year in the 82 male patients was 4.9%. Seventy-six patients (59.4%) developed compensatory hypertrophy in the contralateral kidney during a 1 year follow-up period. Of the total, only seven children (5.5%) had undergone nephrectomy. CONCLUSIONS MCDK follows a benign course with relatively few sequelae, and therefore these patients should be closely followed up and conservatively managed.
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Affiliation(s)
- Aslihan Kara
- Department of Pediatric Nephrology, Firat University School of Medicine, Elazig, Turkey
| | - Metin Kaya Gurgoze
- Department of Pediatric Nephrology, Firat University School of Medicine, Elazig, Turkey
| | - Mustafa Aydin
- Department of Neonatology, Firat University School of Medicine, Elazig, Turkey
| | - Zehra Pinar Koc
- Department of Nuclear Medicine, Firat University School of Medicine, Elazig, Turkey
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16
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Fetal Urinary Tract Anomalies: Review of Pathophysiology, Imaging, and Management. AJR Am J Roentgenol 2018; 210:1010-1021. [DOI: 10.2214/ajr.17.18371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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17
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Marokakis S, Kasparian NA, Kennedy SE. Parents’ perceptions of counselling following prenatal diagnosis of congenital anomalies of the kidney and urinary tract: a qualitative study. BJU Int 2016; 119:474-481. [DOI: 10.1111/bju.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah Marokakis
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; The University of New South Wales; Sydney NSW Australia
| | - Nadine A. Kasparian
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; The University of New South Wales; Sydney NSW Australia
- Heart Centre for Children; The Sydney Children's Hospitals Network (Westmead and Randwick); Sydney NSW Australia
| | - Sean E. Kennedy
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; The University of New South Wales; Sydney NSW Australia
- Department of Nephrology; The Sydney Children's Hospitals Network (Westmead and Randwick); Sydney NSW Australia
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18
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La Scola C, Ammenti A, Puccio G, Lega MV, De Mutiis C, Guiducci C, De Petris L, Perretta R, Venturoli V, Vergine G, Zucchini A, Montini G. Congenital Solitary Kidney in Children: Size Matters. J Urol 2016; 196:1250-6. [DOI: 10.1016/j.juro.2016.03.173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Anita Ammenti
- Department of Pediatrics, University of Parma, Parma, Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Maria Vittoria Lega
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Chiara De Mutiis
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Claudia Guiducci
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Giovanni Montini
- Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
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19
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Psooy K. Multicystic dysplastic kidney (MCDK) in the neonate: The role of the urologist. Can Urol Assoc J 2016; 10:18-24. [PMID: 26977201 DOI: 10.5489/cuaj.3520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Karen Psooy
- University of Manitoba, Winnipeg, MB, Canada
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20
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Eickmeyer AB, Casanova NF, He C, Smith EA, Wan J, Bloom DA, Dillman JR. The natural history of the multicystic dysplastic kidney--is limited follow-up warranted? J Pediatr Urol 2014; 10:655-61. [PMID: 25087179 DOI: 10.1016/j.jpurol.2014.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Imaging of patients with multicystic dysplastic kidney (MCDK) has increased over the past three decades. This increased use of imaging has provided additional insights into the natural history of MCDK. The present study looked at this data for predictors of involution and associated anomalies. METHODS AND MATERIALS Institutional review board approval was obtained for this retrospective study. The University of Michigan Departments of Urology and Radiology records were searched to identify unilateral MCDK patients during 1980-2012. Available clinical, radiological and surgical records were reviewed, and pertinent data were recorded. The log-rank test and a Cox proportional regression analysis were performed to identify predictors of MCDK involution. Probability of involution over time was assessed using Kaplan-Meier methodology. RESULTS 301 unilateral MCDKs were identified; 195 (64.8%) were detected antenatally. Of the MCDKs found, 136 (45.2%) were in girls; 160 (53.2%) were right-sided. Mean size at baseline was 5.0 ± 0.2 cm (Mean ± SE). Associated abnormalities included: contralateral ureteropelvic junction obstruction (n = 10; 3.3%); contralateral ureterovesical junction obstruction/primary megaureter (n = 6; 2.0%); ipsilateral VUR (n = 21; 7.0%); contralateral VUR (n = 63; 20.1%); and renal fusion anomaly (n = 4; 1.3%). The cumulative probability of involution was: 9.8% at one year, 38.5% at five years, and 53.5% at ten years of age. Baseline MCDK size was the only significant predictor of involution at bivariate (p < 0.0001) and multivariate (p < 0.0001; HR 0.58 [95% CI: 0.49, 0.69]) analyses. No MCDK developed malignancy during the follow-up period. CONCLUSION As many MCDKs eventually involute and the risk of associated malignancy appears to be very low, there is no absolute indication for nephrectomy. Based on the data and other recent studies, it is believed that pediatric MCDK patients with no other urologic abnormalities can safely tolerate more limited urological and radiological follow-up.
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Affiliation(s)
- A B Eickmeyer
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - N F Casanova
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - C He
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - E A Smith
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - J Wan
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - D A Bloom
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - J R Dillman
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
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Moralıoğlu S, Celayir AC, Bosnalı O, Pektaş OZ, Bulut IK. Single center experience in patients with unilateral multicystic dysplastic kidney. J Pediatr Urol 2014; 10:763-768. [PMID: 24873872 DOI: 10.1016/j.jpurol.2014.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the clinical features, long-term outcomes, and additional urological anomalies of patients treated for multicystic dysplastic kidney (MDK). MATERIALS AND METHODS Patients with MDK who were followed between January 2004 and October 2012 were reviewed retrospectively. Demographic, clinical, laboratory, and radiological data were evaluated. RESULTS A total of 68 patients with MDK were followed for a mean period of 46.8 ± 32.4 months. MDK was detected by antenatal ultrasound in 64 (94.1%) of the patients. Ten patients had (14.7%) additional urological anomalies in contralateral kidney. Vesicoureteral reflux was found in five patients (7.3%). Other urological anomalies were megaureter (two), cortical renal cyst (two), ureteropelvic junction obstruction (one), and renal ectopy (one). Urinary tract infection was detected in 14 (20.5%) patients. Four (5.9%) patients had hypertension. Compensatory hypertrophy was detected in 29 (42.6%) patients. Eight (11.8%) of these 29 patients had glomerular hyperfiltration and three (4.4%) of these eight patients also had proteinuria. Follow-up ultrasound revealed complete involution in 19 (35.8%) patients. Nephrectomy was performed in 15 (22.0%) patients. Indications of nephrectomy were, recurrent urinary infection (four), hypertension (three), ureterocele (two), renal calculi (one), flank pain (one), hematuria (one), persistent large cystic kidney (three), and atypical US findings (two). CONCLUSION In patients with MDK, depending on the clinical, laboratory, and radiological findings, appropriate timing of operation by multidisciplinary approach is important for early detection and treatment of any possible complications.
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Affiliation(s)
- Serdar Moralıoğlu
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
| | - Ayşenur Cerrah Celayir
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
| | - Oktav Bosnalı
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
| | - Osman Zeki Pektaş
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
| | - Ipek Kaplan Bulut
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Pediatric Nephrology, Istanbul, Turkey.
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Winding L, Loane M, Wellesley D, Addor MC, Arriola L, Bakker MK, Bianchi F, Calzolari E, Gatt M, Haeusler M, Lelong N, Mullaney C, Scarano G, Tucker D, Wiesel A, Garne E. Prenatal diagnosis and epidemiology of multicystic kidney dysplasia in Europe. Prenat Diagn 2014; 34:1093-8. [DOI: 10.1002/pd.4433] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Louise Winding
- Paediatric Department; Hospital Lillebaelt; Kolding Denmark
| | | | | | - Marie-Claude Addor
- Registry of Vaud Switzerland, Division of Medical Genetics; CHUV; Lausanne Switzerland
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government; CIBER Epidemiología y Salud Pública - CIBERESP; Madrid Spain
| | - Marian K. Bakker
- EUROCAT Northern Netherlands, Department of Genetics; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Fabrizio Bianchi
- CNR Institute of Clinical Physiology and G. Monasterio Tuscany Foundation; Pisa Italy
| | - Elisa Calzolari
- Registro IMER - IMER Registry (Emila Romagna Registry of Birth Defects); Azienda Ospedaliero-Universitaria di Ferrara; Ferrara Italy
| | - Miriam Gatt
- Malta Congenital Anomalies Register; Directorate for Health Information and Research; Valletta Malta
| | | | | | - Carmel Mullaney
- South East Ireland Congenital Anomaly (EUROCAT) Registry, Public Health Department; HSE South (South East); Kilkenny Ireland
| | | | | | - Awi Wiesel
- Department of Paediatrics; University Medical Centre of the Johannes Gutenberg University Mainz; Mainz Germany
| | - Ester Garne
- Paediatric Department; Hospital Lillebaelt; Kolding Denmark
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23
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Hayes WN, Watson AR. Unilateral multicystic dysplastic kidney: does initial size matter? Pediatr Nephrol 2012; 27:1335-40. [PMID: 22410799 DOI: 10.1007/s00467-012-2141-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We report the long-term follow-up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) who were followed between 1985 and 2009. METHODS Involution rates were documented over time based on the initial size of the MCDK, as documented on postnatal ultrasound (USS), as well as long-term complications and renal function. RESULTS In 323 patients (182 male), 10 % of MCDK had involuted, as evidenced on the first postnatal USS, with survival function analysis showing the probability of complete involution to be 35 % in 249 patients by 2 years of age, 47 % in 180 patients by 5 years of age and 62 % in 94 patients by 10 years of age. There was a significant difference in the involution rates of MCKD at the 10-year follow-up between MCDK with an initial size of >5 cm versus MCDK with an initial size of ≤5 cm (p < 0.0001). No patients in the whole cohort developed sustained hypertension or malignancy during a median follow-up of 10.1 years (range 0.3-15.4 years). Median estimated glomerular filtration rate (eGFR) in 76 patients (7 at 5 years, 69 at 10 years) was 93 ml/min/1.73 m(2) (range 46-175 ml/min/1.73 m(2)), with 40 (53%) having an eGFR of between 90 and 140 ml/min/1.73 m(2). Twenty-three (30 %) of the 76 patients at 10 years had normal eGFR (90-140 ml/min/1.73 m(2)) as well as complete involution of the MCDK, compensatory hypertrophy of the contralateral kidney, no proteinuria and no hypertension. CONCLUSIONS Larger MCDK at birth are less likely to involute during the first decade of life. However, conservative management remains justified due to the lack of complications. A minority of patients fulfil current criteria for discharge from specialty follow-up at 10 years.
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Affiliation(s)
- Wesley N Hayes
- Children's Renal & Urology Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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24
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Unilateral Multicystic Dysplastic Kidney With Progressive Infundibular Stenosis in the Contralateral Kidney: Experience at 1 Center and Review of Literature. J Urol 2011; 186:1053-8. [DOI: 10.1016/j.juro.2011.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Indexed: 11/23/2022]
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Abstract
INTRODUCTION Although multicystic dysplastic kidney (MDK) is a common renal anomaly, the management of this condition remains controversial. The purpose of this study was to focus on its regression by ultrasound (US) scan for MDK managed conservatively. MATERIALS AND METHODS Between 1990 and 2010, 50 children with MDK were retrospectively studied. All patients were submitted to radioisotope scan to confirm the diagnosis, and a micturating cystogram to exclude other uropathies. RESULTS Of the 50 patients, 19 underwent nephrectomy, and the other 31 were conservatively managed with clinical and US scan follow-up. The mean follow-up time (range 6 months to 11 years) in the non-operated group was 6.2 years. Of the 31 children with nonsurgical management, 17 (54.8%) showed total involution on US scan, 7 (22.6%) showed a partial regression, and 7 (22.6%) were unchanged at the time of this study. The mean time to complete disappearance on US scan was 2.5 years (1-4 years). No children developed hypertension or tumors. DISCUSSION The natural history of MDK is usually benign, but patients must have long-term follow-up with US scan. In addition, many studies confirmed that the disappearance of it on a US scan does not mean a total involution of the affected kidney. We recommend a strict follow-up even when US scan shows an undetectable kidney.
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Long-term risk of chronic kidney disease in unilateral multicystic dysplastic kidney. Pediatr Nephrol 2011; 26:597-603. [PMID: 21240528 DOI: 10.1007/s00467-010-1746-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/05/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
The clinical spectrum of renal dysplasia includes the non-functioning multicystic dysplastic kidney (MCDK). We report our experience of the outcome of unilateral MCDK and its contralateral kidney in 101 children with the diagnosis of MCDK from 1985 to 2009. Data collected included urine protein/creatinine ratio, estimated GFR (eGFR), blood pressure, surgical intervention, renal length and abnormalities of the contralateral kidney, and the involution rate. There was a predominance of left-sided MCDK. Diagnosis was made prenatally in 86.7%. Contralateral abnormalities included vesicoureteral reflux (16.8%), UPJ obstruction (4.1%), and megaureter (2.4%). Complete involution of MCDK occurred within 5 years in 60%. Compensatory hypertrophy of the contralateral kidney to >97% occurred in 74.1%. Nephrectomy was performed in 19.8%. There was an increased risk of chronic kidney disease (CKD) stage ≥ 2, and hypertension in those with contralateral abnormalities (p<0.0001; p<0.001 respectively). In those without contralateral abnormalities, hyperfiltration with mean eGFR of 149 ± 13 ml/min/1.73 m(2) was seen in 32% and proteinuria in 9.8%. There was a significantly inverse relationship between proteinuria and eGFR (p<0.0001). In conclusion, children with contralateral abnormalities are at risk for developing decreased kidney function, whereas a substantial number of patients with no obvious contralateral abnormalities have markers of renal injury. Therefore, systematic follow-up of all patients is recommended.
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Schreuder MF, Westland R, van Wijk JAE. Unilateral multicystic dysplastic kidney: a meta-analysis of observational studies on the incidence, associated urinary tract malformations and the contralateral kidney. Nephrol Dial Transplant 2009; 24:1810-8. [PMID: 19171687 DOI: 10.1093/ndt/gfn777] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many papers are published on cohorts with unilateral multicystic dysplastic kidney (MCDK) patients, but show variable results as to the incidence of associated urinary tract abnormalities. The objective of this study was to describe the status of the urinary tract, including contralateral hypertrophy and malformations, in patients with unilateral MCDK based on a meta-analysis of the literature, taking into account the timing of diagnosis (pre- versus postnatal) as a possible source of bias. METHODS A systematic review of the scientific literature in English was conducted using PubMed and Embase. A meta-analysis was performed with the studies that were identified using our reproducible search. RESULTS Based on analysis of the data in 19 populations, the overall incidence of unilateral MCDK is 1 in 4300 with an increasing trend over the years. A total of 67 cohorts with over 3500 patients with unilateral MCDK were included in the meta-analysis. Fifty-nine percent of patients were male and the MCDKs were significantly more often found on the left side (53.1%). Associated anomalies in the solitary functioning kidney were found in 1 in 3 patients, mainly vesicoureteric reflux (VUR, in 19.7%). In patients with VUR, 40% have severe contralateral VUR, defined as grade III-V. Contralateral hypertrophy, present in 77% of patients after a follow-up of at least 10 years, showed a trend to be less pronounced in patients with VUR. Timing of the diagnosis of MCDK did not essentially influence the results. CONCLUSIONS These aggregate results provide insight into the incidence, demographic data and associated anomalies in patients with unilateral MCDK. One in three patients with unilateral MCDK show anomalies in the contralateral, solitary functioning kidney. However, studies into the long-term consequences of these anomalies are scarce.
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Affiliation(s)
- Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud University Nijmegen Medical Centre, Amsterdam, The Netherlands.
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