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Chaki S, Mclarty R, Mzolo I, Rajan S, Chipongo H. A Rare Case of Antenatal Bilateral Multicystic Dysplastic Kidney Disease: An Unusual Presentation in a Neonate. Clin Case Rep 2025; 13:e70407. [PMID: 40201795 PMCID: PMC11975539 DOI: 10.1002/ccr3.70407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/24/2025] [Accepted: 03/25/2025] [Indexed: 04/10/2025] Open
Abstract
This report highlights a deadly presentation of Multicystic dysplastic kidney (MCDK) diagnosed in utero and confirmed after 6 weeks post-delivery by ultrasonography. In this case, we present a neonate followed for a period of 6 weeks after delivery without any notable complications. From the literature point of view, this condition is incompatible with life and there are few cases reported in sub-Saharan Africa. There is no definitive treatment for such a case; only watchful waiting and serial renal function tests are used to monitor complications to date. Hence, this case opens a window for other researchers to evaluate this course, especially in resource-limited settings.
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Affiliation(s)
- Samina Chaki
- Department of Pediatrics and Child HealthShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Ronald Mclarty
- Department of Pediatrics and Child HealthShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Isack Mzolo
- Department of Radiology and Diagnostic ImagingShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Shaffin Rajan
- Critical Care DepartmentShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Hilary Chipongo
- Critical Care DepartmentShree Hindu Mandal HospitalDar es SalaamTanzania
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Vandana G, Karunakar P, Krishnasamy S, Sivakumar RR, Deepthi B, Kumar BH, Palanisamy S, Ananthakrishnan R, Krishnamurthy S. Clinical Characteristics and Outcomes of Children with Unilateral Multicystic Dysplastic Kidney: A Cohort Study. Indian Pediatr 2025; 62:203-209. [PMID: 40126836 DOI: 10.1007/s13312-025-00006-8] [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] [Accepted: 02/21/2025] [Indexed: 03/26/2025]
Abstract
OBJECTIVES To study the clinical profile and outcomes of children with unilateral multicystic dysplastic kidney (MCDK). METHODS We assessed the clinical features and extrarenal manifestations in children with unilateral MCDK. These children were followed up to ascertain involution, compensatory hypertrophy and progression of chronic kidney disease (CKD) stage. RESULTS We enrolled 106 children with unilateral MCDK which was detected antenatally in 98 (92.4%), while evaluating for urinary tract infection in three (2.8%), and incidentally in five (4.7%) children. Abnormalities in the contralateral kidney and extrarenal manifestations at initial presentation were detected in 30 (28.3%) and 15 (14.2%), respectively. At a median (IQR) follow-up of 60 (32, 87) months, 34 (32.1%) children demonstrated complete involution of the MCDK, while 72 (67.9%) showed compensatory hypertrophy in the contralateral kidney. The median age at involution of MCDK was 48.5 (33, 86.5) months. Twenty-two (20.7%) children had non-regression of MCDK, and two (1.9%) underwent nephrectomy. Eight (7.5%) children developed hypertension and two children were detected to have proteinuria. One child, each, progressed to CKD stage 2 and stage 3a; and another child (0.9%) progressed to end stage kidney disease. None of the patients developed malignant transformation. CONCLUSIONS Majority of cases (92.4%) of MCDK had been detected antenatally. The rate of involution was 32.1% at a median follow-up of 60 months. Although, 28.3% of cases of MCDK had abnormalities in the contralateral kidney, progression of CKD to a higher stage occurred only in three (2.8%) cases.
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Affiliation(s)
- Gurram Vandana
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Pediredla Karunakar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Sudarsan Krishnasamy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Ramachandran Ramge Sivakumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Bobbity Deepthi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Bondada Hemanth Kumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Sivamurukan Palanisamy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Ramesh Ananthakrishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
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Harmer MJ, Stewart DJ, Prasad P, Veligratli F, Pickles C, Kim JS, Raja M. Unilateral Multicystic Dysplastic Kidney Management: A National Survey. Clin Pediatr (Phila) 2024; 63:482-487. [PMID: 37278332 DOI: 10.1177/00099228231177808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Risks of contralateral kidney abnormalities and chronic kidney disease necessitate follow-up for unilateral multicystic dysplastic kidneys (MCDK). A nationwide survey of senior UK pediatricians was conducted. Of the 60 responses obtained, 62% routinely perform a dimercaptosuccinic acid scan to confirm diagnosis. Eight percent routinely perform a cystogram to investigate contralateral vesicoureteric reflux. Sixty-two percent would routinely measure renal function (frequency ranging from once only to "every 2 years"). Twenty-five percent recalled MCDK nephrectomy being performed within the previous 5 years. Respondents voiced concerns that national guidance may result in an overcautious approach but could balance consensus and safe variation, and offer families choice and reassurance. The mean estimated cost of follow-up from birth to 18 years ranged from £258 to £3854. Results demonstrate significant variation in management, highlighting the need for a clear pathway to decrease unwanted variability and to ensure those at high risk of renal sequelae are recognized early, without undue investigatory burden.
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Affiliation(s)
- Matthew J Harmer
- Department of Paediatric Nephrology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Douglas J Stewart
- Department of Paediatric Nephrology, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pallavi Prasad
- Department of Paediatric Nephrology, Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Faidra Veligratli
- Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Charles Pickles
- Department of Paediatric Nephrology, Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ji Soo Kim
- Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maduri Raja
- Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Chaubal R, Pokhriyal SC, Deshmukh A, Gupta U, Chaubal N. Multicystic Dysplastic Kidney Disease: An In-Utero Diagnosis. Cureus 2023; 15:e37786. [PMID: 37214047 PMCID: PMC10195076 DOI: 10.7759/cureus.37786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Multicystic dysplastic kidney (MCDK) is a congenital cystic kidney disease that can be incidentally seen during the antenatal ultrasound. The condition is most commonly asymptomatic. The clinical presentation is usually characterized by multiple small cysts or a single dominating cyst in the fetal kidney depending on the type of MCDK. Most cases undergo spontaneous involution, and complications like hypertension, infection, and malignancy are rare. We present the case of a young Primigravida who was diagnosed to have a fetus with unilateral MCDK in the second trimester and further followed up later in pregnancy as well as four months postnatally. The pregnancy was unremarkable, but for the diagnosis of MCDK in the second trimester; the infant was doing well at the four-month follow-up. Pre-natal ultrasound and MRI are able to diagnose MCDK reliably. Conservative management and follow-up is currently the most common protocol used to manage MCDK.
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Affiliation(s)
- Rajas Chaubal
- Obstetrics and Gynaecology, Jaslok Hospital & Research Centre, Mumbai, IND
| | | | - Amol Deshmukh
- Obstetrics and Gynaecology, Thane Ultrasound Centre, Mumbai, IND
| | - Uma Gupta
- Internal Medicine, Interfaith Medical Center, New York, USA
| | - Nitin Chaubal
- Obstetrics and Gynaecology, Jaslok Hospital & Research Centre, Mumbai, IND
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Alamir A, Al Rasheed SA, Al Qahtani AT, Almosa MS, Aljehani ND, Alanazi ED, Almutairi KA. The Outcome of Multicystic Dysplastic Kidney Disease Patients at King Abdulaziz Medical City in Riyadh. Cureus 2023; 15:e37994. [PMID: 37223165 PMCID: PMC10202889 DOI: 10.7759/cureus.37994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Background Multicystic dysplastic kidney (MCDK) is a type of kidney dysplasia consisting of many irregular, various-sized cysts divided by dysplastic renal tissue, which negatively impacts kidney function. MCDK is one of the most common renal congenital disorders seen in antenatal ultrasounds. The typical prognosis of MCDK is complete or partial involution that starts antenatally and continues postnatally. The aim of the study was to shed light on the overall outcome of patients with MCDK. Methods We retrospectively collected data on MCDK patients from 2016 until 2022 at King Abdulaziz Medical City, Ministry of National Guard Health Affairs in Saudi Arabia, Riyadh. The data included the recording of epidemiological data, radiological and laboratory reports, and the presence of urological or non-urologically associated anomalies. Results A total of 57 patients with MCDK were reviewed. Seven of them were excluded due to the diagnosis of bilateral MCDK, which was incompatible with life. Of the remaining 50 patients, the right kidney was affected in 52% of them. Most patients were diagnosed antenatally (98%). The mean duration of follow-up for the study was 48 months. Vesicoureteral reflux (VUR) was detected in 22% of the total sample. Overall, 90% of the patients underwent kidney involution. A small percentage had genitourinary anomalies (20%), while a larger percentage (48%) had extrarenal abnormalities. Conclusion Multicystic dysplastic kidney disease is relatively common in children. The prognosis is affected by the presence of genitourinary and non-genitourinary anomalies. Patients have an overall good prognosis with conservative management. Antenatal screening, diagnosis, and long-term nephrological follow-up are essential for the optimal management of patients.
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Affiliation(s)
- Abdulrahman Alamir
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Soud A Al Rasheed
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Abdullah T Al Qahtani
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Mohammad S Almosa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nawaf D Aljehani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Eid D Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid A Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Rousset-Rouvière C. [Developmental abnormalities of the kidney]. Med Sci (Paris) 2023; 39:219-226. [PMID: 36943118 DOI: 10.1051/medsci/2023032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Les anomalies du développement rénal sont fréquentes chez le fœtus et correspondent à un défaut des étapes de la néphrogenèse. La plupart d’entre elles ont une évolution favorable, mais la gravité potentielle de certaines malformations rend leur dépistage et leur prise en charge précoce essentiels. Le dépistage de ces anomalies repose sur l’échographie fœtale. L’échographie devra préciser le pronostic de l’anomalie en recherchant des critères de gravité, tels qu’une atteinte rénale bilatérale, une altération de la quantité de liquide amniotique, témoin d’une altération de la fonction rénale fœtale, ou encore l’existence d’atteintes extra-rénales associées. Dans les cas les plus sévères, une prise en charge dans un centre pluridisciplinaire de diagnostic prénatal (CPDPN) est indispensable. Les anomalies du développement rénal peuvent être isolées ou s’inscrire dans le cadre d’un syndrome poly-malformatif. L’apport de la génétique dans la compréhension de ces anomalies est d’une aide considérable.
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Affiliation(s)
- Caroline Rousset-Rouvière
- Service de pédiatrie multidisciplinaire, Assistance Publique-Hôpitaux de Marseille (AP-HM) Timone-Enfants, 13385 Marseille cedex 05, France
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Kopač M, Kordič R. Associated Anomalies and Complications of Multicystic Dysplastic Kidney. Pediatr Rep 2022; 14:375-379. [PMID: 36136083 PMCID: PMC9504218 DOI: 10.3390/pediatric14030044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To assess multicystic dysplastic kidneys (MCDK) in children, their complications and associated congenital genitourinary anomalies. METHODS Children with unilateral MCDK, evaluated between 2012 and 2020, were analyzed. In this retrospective study, data were obtained from electronic and paper health care records. RESULTS There were 80 children included. Follow-up time was 8.0 +/- 5.2 years (mean +/- standard deviation). None of them had hypertension. In total, 43.8% of the children had associated congenital genitourinary anomalies, most commonly cryptorchidism and vesicoureteral reflux (VUR), and 6.3% of these children had chromosomopathy. All of them had normal kidney function except one child with dysplasia of the contralateral kidney. Urinalysis was normal in 90% of children. Extrarenal malformations occurred in 22.5% of them. We observed spontaneous involution of MCDK in 38.8% of children in the observed period. Nephrectomy was performed in 12.5% of children, at an average age of 2.0 years. CONCLUSIONS Children with a unilateral MCDK have a very good prognosis if the contralateral kidney is normal. Associated congenital genitourinary anomalies are common. Cryptorchidism was found to be the most common associated anomaly among boys, which is unique for this study. Most of these children do not suffer from hypertension, kidney dysfunction or other complications.
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Affiliation(s)
- Matjaž Kopač
- Division of Pediatrics, Department of Nephrology, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-522-9626; Fax: +386-1-522-9620
| | - Robert Kordič
- Division of Surgery, Department of Pediatric Surgery, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
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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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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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Akbalık Kara M, Taktak A, Alparslan C. Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey. Turk J Med Sci 2021; 51:1331-1337. [PMID: 33512816 PMCID: PMC8283448 DOI: 10.3906/sag-2011-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background/aim The objective of this study is to determine the clinical features of unilateral multicystic dysplastic kidney (MCDK) patients. Materials and methods The demographic, clinical, laboratory, and radiologic features of MCDK patients at Diyarbakır Children’s Hospital and Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2008-June 2019 were retrospectively evaluated. Results A total of 111 [59 (53.2%) male and 52(46.8%) female] patients with MCDK were followed for a mean period of 41.89 ± 32.03 months. MCDK was located on the left and right sides in 46 (41.4%) and 65 (58.6%) of the children, respectively (p > 0.05). A total of 87 (78.4%) patients had antenatal diagnosis. The mean age at diagnosis was 13.7 ± 34.2 months. Of the 49 voiding cystourethrogram (VCUG)-performed patients, vesicoureteral reflux was detected in 11 patients (22.4%). Other associated urological anomalies in the patients were detected in 12 (10.8%) patients. On Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy which was performed in all patients showed scarring in four children. Eight patients had history of UTI (7.2%). Renal failure, hypertension, and proteinuria were diagnosed in three children (2.7%). Sixty-nine (62%) patients developed compensatory hypertrophy. Conclusion All cases should be followed up closely and VCUG should be reserved for patients with recurrent UTI and other urological problems indicated by ultrasonography and abnormal DMSA scan results.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Aysel Taktak
- Department of Pediatric Nephrology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Caner Alparslan
- Department of Pediatric Nephrology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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11
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Trends in surgical management of multicystic dysplastic kidney at USA children's hospitals. J Pediatr Urol 2019; 15:368-373. [PMID: 31130502 DOI: 10.1016/j.jpurol.2019.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/24/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE Multicystic dysplastic kidney (MCDK) is a congenital renal cystic disease often incidentally diagnosed in children. Historically, children with MCDK underwent early nephrectomy because of concerns for the development of hypertension or malignancy. Over the last decade, management recommendations have not supported routine early surgical removal of MCDK. The study authors sought to determine the current trends in the use of nephrectomy for MCDK in US children's hospitals because national practice patterns have not been investigated. METHODS A population-based retrospective cohort study using the Pediatric Health Information System (PHIS) was conducted. The study population was comprised of patients aged 0-18 years with a diagnosis of MCDK (International Classification of Diseases-9th revision, code 753.19) admitted to the inpatient department of the study hospital between January 2006 and September 2015. Patients with additional renal anomalies including polycystic kidney, medullary cystic kidney, and medullary sponge kidney were excluded, as were patients treated in a hospital that did not contribute data to the PHIS continuously throughout the study period. Trends in the annual proportion of nephrectomies performed were analyzed among admissions in the study population, along with patient clinical and demographic information. RESULTS A total of 3792 MCDK admissions, in 34 hospitals, were included in the study. Overall, 569 nephrectomies were performed during the study period. The proportion of nephrectomy decreased annually by 9.2% on average, from 22.1% in 2006 to 7.3% in the first 3 quarters of 2015. No significant trends were observed in the annual number of overall MCDK admissions or patient age at procedure among patients who had a nephrectomy. Among nephrectomies, 84.2% were open and 15.8% were minimally invasive procedures (laparoscopic non-robotic, 10% and robotic, 5.8%). The proportion of minimally invasive nephrectomies increased annually by 13.7%, from 8% in 2006 to 29% in 2015. DISCUSSION Trends in the use of nephrectomy for MCDK at a national level have not been previously reported. This study is limited by the use of inpatient discharge data, which did not allow estimating the true rate of nephrectomy in patients born with MCDK. CONCLUSIONS During the study period, there has been a decrease in the use of nephrectomy for MCDK in pediatric hospitals, along with a concurrent increase in utilization of minimally invasive techniques to perform nephrectomies. These results suggest that in general, urologists at freestanding children's hospitals are heeding recommendations for observation and against routine early surgical removal of these kidneys; although trends in the use of nephrectomy varied between hospitals, there is room for continued improvement in following these recommendations.
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Zambaiti E, Sergio M, Baldanza F, Corrado C, Di Pace MR, Cimador M. Correlation between hypertrophy and risk of hypertension in congenital solitary functioning kidney. Pediatr Surg Int 2019; 35:167-174. [PMID: 30374633 DOI: 10.1007/s00383-018-4389-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Solitary functioning kidney (SFK) may be associated to hypertrophy, hypertension and chronic kidney disease. We evaluated blood pressure (BP) of children with congenital SFK comparing agenesis to multicystic dysplastic kidney (MCDK) and correlated BP profiles with renal dimensions of affected and contralateral kidney. METHODS We compared 40 patients with MCDK, grouped for either treatment options (A: conservative vs B: nephrectomy) or involution time (A1: before 4 years-of-age vs A2: persistence-of-MCDK), to 10 unilateral agenesis (C). Patients were evaluated with ultrasound, scintigraphy, office-ambulatory BP monitoring. RESULTS Compensatory hypertrophy was demonstrated in most of the subjects, without differences between subgroups, with an increase over time (p < 0.001). A1-C showed an overall percentage of hypertrophy significantly higher than A2-B (83%-88% vs 70%-73%, respectively; p = 0.03); moreover, cumulative risk to develop hypertension in A1-C is significantly higher compared to A2-B in office and ambulatory BP monitoring (p = 0.03). Insufficient dipping in systolic and/or diastolic BP was found in 82% children, without differences between subtypes. CONCLUSIONS Patients with a small/absent dysplastic kidney have an increased risk to develop hypertrophy and hypertension compared to patients with a large residual, regardless of nephrectomy. ABPM revealed absent dipping in most patients with SFK, warning further investigations in apparently not symptomatic patients.
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Affiliation(s)
- Elisa Zambaiti
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127, Palermo, Italy.
| | - Maria Sergio
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127, Palermo, Italy
| | - Fabio Baldanza
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127, Palermo, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, Children's Hospital 'G. Di Cristina', A.R.N.A.S. 'Civico', Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - Maria Rita Di Pace
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127, Palermo, Italy
| | - Marcello Cimador
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127, Palermo, Italy
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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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14
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Friedman MA, Aguilar L, Heyward Q, Wheeler C, Caldamone A. Screening for Mullerian anomalies in patients with unilateral renal agenesis: Leveraging early detection to prevent complications. J Pediatr Urol 2018; 14:144-149. [PMID: 29459133 DOI: 10.1016/j.jpurol.2018.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mullerian anomalies have a known association with renal agenesis yet, to date, there are no formal recommendations for screening women with certain renal anomalies for associated genital tract disorders. OBJECTIVE The objective of this study is to review current data regarding the association between renal and Mullerian anomalies, and propose screening recommendations. STUDY DESIGN A comprehensive review of the literature was performed to identify relevant articles using the keywords "unilateral renal agenesis," "renal anomalies," and "Mullerian anomalies." RESULTS Over 30% of patients with unilateral renal agenesis have an associated Mullerian anomaly. However, diagnosis is frequently delayed in this population until after menarche when complications of retrograde menstruation with obstructive anomalies lead to significant problems including endometriosis, pelvic inflammatory disease, and infertility. No clear guidelines exist for communication among the antenatal sonographer, the obstetrician, the parents, and the child's pediatrician, which creates a barrier to effective screening and follow-up. Further, no current guidelines exist for screening women with certain renal anomalies for Mullerian anomalies. DISCUSSION The complications of Mullerian anomalies are easily preventable if identified early. We propose new guidelines for education and screening for Mullerian anomalies in patients with unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK) to guide providers, patients, and parents on proper identification and management (Table). CONCLUSIONS Screening young women with URA and MCDK for Mullerian anomalies has the potential to prevent long-term complications from untreated obstructive malformations. Identification of unilateral renal agenesis on antenatal ultrasound must be clearly articulated with parents and the child's pediatrician so that proper screening can be performed before menarche. Pelvic sonography is a low-cost, high-yield screening tool to identify these anomalies.
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Affiliation(s)
- M Alexandra Friedman
- Brown University, Department of Obstetrics and Gynecology, The Warren Alpert Medical School, Providence, RI, USA.
| | - Liza Aguilar
- Brown University, Division of Pediatric Urology, Hasbro Children's Hospital, The Warren Alpert Medical School, Providence, RI, USA
| | - Quetrell Heyward
- Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Carol Wheeler
- Brown University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, The Warren Alpert Medical School, Providence, RI, USA
| | - Anthony Caldamone
- Brown University, Division of Pediatric Urology, Hasbro Children's Hospital, The Warren Alpert Medical School, Providence, RI, USA
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Molina CAF, Bessa Junior J, Estevanato AG, Viana GS, Facincani I, Netto JMB, Tucci Junior S. Applicability of Laparoscopic Nephrectomy in the Treatment of Multicystic Dysplastic Kidney: Sorting Out Surgical Indication. Cureus 2018. [PMID: 29515943 PMCID: PMC5832395 DOI: 10.7759/cureus.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction We evaluated the applicability of laparoscopic nephrectomy in the treatment of multicystic dysplastic kidney (MCDK) in children, including procedures performed by resident physicians or trainees in surgical urology. Methods We retrospectively evaluated the medical records of 20 children with MCDK who underwent laparoscopic nephrectomy over a six-year period. Data collected included gender, laterality of the affected kidney, age at the time of surgery, the largest diameter of the multicystic kidney and associated urological diagnoses, surgical, and postoperative data. All surgical procedures were performed transperitoneally. Results The mean age at the time of surgery was 46 months with a slight predominance of girls. The right side was the more affected side, and the average diameter of the affected kidney at the time of surgical excision was 5.8 cm. Other changes in the urinary tract were found in five children. The mean operative time was 133 minutes. On pathological examination, on average, the pieces measured 4.8 cm and weighed 18.1 g. There were no operative complications. The average length of hospital stay was 37.35 hours. Conclusion Laparoscopic nephrectomy was confirmed as an applicable treatment for MCDK. The technique was easy to perform, safe and efficient, even when performed by trainees in pediatric urology.
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Affiliation(s)
- Carlos Augusto F Molina
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Jose Bessa Junior
- Division of Urology, Department of Surgery, Universidade Estadual De Feira De Santana - UEFS
| | - Andrey G Estevanato
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Ùsp)
| | - Gustavo S Viana
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Inalda Facincani
- Division of Pediatric Nephrology, Department of Pediatrics and Childcare, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Jose Murillo Bastos Netto
- Division of Urology, Department of Surgery, Federal University of Juiz De Fora (ufjf)and Hospital E Maternidade Therezinha De Jesus of the School of Medical Sciences and Health of Juiz De Fora (hmtj/suprema)
| | - Silvio Tucci Junior
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
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Gaither TW, Patel A, Patel C, Chuang KW, Cohen RA, Baskin LS. Natural History of Contralateral Hypertrophy in Patients with Multicystic Dysplastic Kidneys. J Urol 2018. [DOI: 10.1016/j.juro.2017.06.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas W. Gaither
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Ankur Patel
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Chandni Patel
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Kai-wen Chuang
- Department of Urology, University of California, Irvine, Irvine, California
| | - Ronald A. Cohen
- Department of Diagnostic Imaging, UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | - Laurence S. Baskin
- Department of Urology, University of California, San Francisco, San Francisco, California
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17
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Scala C, McDonnell S, Murphy F, Leone Roberti Maggiore U, Khalil A, Bhide A, Thilaganathan B, Papageorghiou AT. Diagnostic accuracy of midtrimester antenatal ultrasound for multicystic dysplastic kidneys. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:464-469. [PMID: 27643400 DOI: 10.1002/uog.17305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To establish the diagnostic accuracy of obstetric ultrasound at a tertiary fetal medicine center in the prenatal detection of unilateral and bilateral multicystic dysplastic kidney (MCDK) in fetuses in which this condition was suspected, and to undertake a systematic review of the relevant literature. METHODS This was a retrospective observational study of all cases referred to a regional tertiary fetal medicine unit due to suspicion of either unilateral or bilateral MCDK between 1997 and 2015. Diagnosis was confirmed by postnatal ultrasound reports or postmortem examination. The accuracy of prenatal ultrasound in the diagnosis of MCDK was calculated. Using a systematic search strategy we also performed a review of the literature regarding the prenatal diagnosis and diagnostic accuracy of MCDK. RESULTS We included 144 women in our analysis; 37 (25.7%) opted for pregnancy termination (TOP) (due to unilateral MCDK with additional abnormalities, suspected bilateral MCDK or severe obstructive uropathy). Complete pre- and postnatal data were available in 126 pregnancies, including 104 livebirths, 19 TOPs with postmortem findings available and three intrauterine fetal deaths. Two infants died shortly after birth (due to known bilateral MCDK or known cranial vault defect). The overall number of cases of MCDK confirmed postnatally was 100; of these, 98 were diagnosed prenatally (true positive), while two were thought to be hydronephrosis prenatally (false negative) and the diagnosis of MCDK was made after birth. In nine cases, the initial antenatal diagnosis of suspected MCDK was revised, either later in pregnancy (n = 2) or postnatally (n = 7) (false positive). Overall, the diagnostic accuracy in our population for the use of antenatal ultrasound to detect MCDK was 91.3%, while that reported in the existing literature was found to range from 53.3% to 100%. MCDK was isolated in the majority (71%) of cases, while in 29% of cases it was found to be associated with other renal and extrarenal fetal abnormalities. CONCLUSIONS Antenatal ultrasound had a diagnostic accuracy of about 91% in the prediction of postnatal MCDK and can therefore be used to guide antenatal counseling. However, prenatal or postnatal revision of the diagnosis occurred in about 7% of cases and parents should be counseled appropriately. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Scala
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - S McDonnell
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - F Murphy
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - U Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino, IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Bhide
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - B Thilaganathan
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A T Papageorghiou
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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18
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Dimala CA, Bechem NN, Kadia BM, Feteh VF, Choukem SP. Diagnostic and therapeutic challenges of an ambiguous cystic kidney disease in a resource limited setting: a case report. BMC Res Notes 2017; 10:114. [PMID: 28249589 PMCID: PMC5333378 DOI: 10.1186/s13104-017-2437-8] [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: 09/13/2016] [Accepted: 02/24/2017] [Indexed: 12/03/2022] Open
Abstract
Background Unilateral renal cystic disease is a rare condition that shares morphological similarities with multicystic dysplastic kidney, the former often distinguished from the latter on some clinical and histopathological grounds. However serious diagnostic and therapeutic dilemmas set in when there is a considerable overlap in the distinguishing features between these entities. Case presentation A 19-year-old African female presented with a chronic severe debilitating right lower quadrant abdominal pain refractory to analgesics. Biochemical investigations and imaging studies revealed a non-functional polycystic right kidney and no identifiable pelvicalyceal system or ureter but with preserved renal function. The marked overlap in clinical presentation between unilateral renal cystic disease and multicystic dysplastic kidney in this patient necessitated further investigation to pose an appropriate diagnosis. A right nephrectomy was performed and histopathological analysis of the resected kidney done, the results of which were more consistent with unilateral renal cystic disease. The post-operative course was favorable. Conclusion Unilateral renal cystic disease with an ipsilateral non-functional kidney and an atretic pelvicalyceal system is a very rare condition that needs to be distinguished from multicystic dysplastic kidney in order to guide management and set prognosis. A suspicion of either of these diseases therefore warrants a thorough clinical evaluation and the appropriate combination of biochemical and imaging investigations.
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Affiliation(s)
- Christian Akem Dimala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Orthopaedics Department, Southend University Hospital, Essex, UK. .,Health and Human Development (2HD) Research Group, Douala, Cameroon.
| | | | | | - Vitalis Fambombi Feteh
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Mboppi Baptist Hospital, Douala, Cameroon
| | - Simeon Pierre Choukem
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Douala General Hospital, Douala, Cameroon
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Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment. Actas Urol Esp 2017; 41:62-67. [PMID: 27666954 DOI: 10.1016/j.acuro.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/14/2016] [Accepted: 05/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment. MATERIAL AND METHODS A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney. RESULTS Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years. CONCLUSIONS In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings.
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Abstract
Multicystic dysplastic kidney (MCDK) is the most common cause of cystic disease in children. It is characterized by multiple non-communicating cysts of varying sizes with no identifiable normal renal parenchyma. The incidence ranges from 1 in 1000 to 4300 live births, and it is one of the most commonly detected anomalies on prenatal ultrasound. MCDK has been shown to follow a benign course with relatively few sequelae and therefore should be managed conservatively. Currently, the key clinical questions revolve around the detection of anomalies in the contralateral kidney and follow-up imaging. The recent literature suggests that very limited radiographic evaluation of the MCDK is needed. The use of voiding cystourethrogram or nuclear medicine renal scans should be directed by any abnormalities on renal ultrasound or the development of urinary tract infections.
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Affiliation(s)
- Diana Cardona-Grau
- Albany Medical College, Albany Medical Center, South Clinical Campus, 23 Hackett Blvd, MC-208, Albany, NY, 12208, USA,
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21
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Re: Multicystic Dysplastic Kidney: Is an Initial Voiding Cystourethrogram Necessary? J Urol 2016; 195:477. [DOI: 10.1016/j.juro.2015.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Soliman NA, Ali RI, Ghobrial EE, Habib EI, Ziada AM. Pattern of clinical presentation of congenital anomalies of the kidney and urinary tract among infants and children. Nephrology (Carlton) 2016; 20:413-8. [PMID: 25645028 DOI: 10.1111/nep.12414] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 12/15/2022]
Abstract
AIM Congenital anomalies of the kidneys and urinary tract (CAKUT) comprise various entities of structural malformations that result from defects in morphogenesis of the kidney and/or urinary tract. These anomalies are the most commonly diagnosed malformations in the prenatal period and constitute the leading cause of end-+stage renal disease (ESRD) in children, worldwide. This prospective study was performed to report the patterns of clinical presentation and diagnosis of infants and children with such malformations. METHODS Patients with suggestive features of CAKUT, presenting to Cairo University Children Hospital over one year duration were investigated and categorized based on underlying renal structural/functional malformation and associated extra-renal anomalies. RESULTS One hundred and seven CAKUT children were enrolled in the study. Familial clustering was identified in 14% of the cohort and syndromic CAKUT accounted for 31.8% of cases. Different anomaly entities have been identified; posterior urethral valves (PUV) being the commonest detected abnormality (36.4%). Of note, 9.3% of cohort patients had ESRD at presentation, of which 60% had PUV as their primary renal disease. Obstructive cases were noted to present significantly earlier and attain advanced CKD stages rather than non-obstructive ones. CONCLUSION CAKUT is a clinically heterogeneous group of diseases with diverse clinical phenotypes. More efforts should be aimed at improving antenatal detection as well as classification with comprehensive reference to the clinical, genetic and molecular features of the diseases. The high frequency of familial and syndromic CAKUT among studied patients is seemingly a convincing reason to pursue the underlying genetic defect in future studies.
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Affiliation(s)
- Neveen A Soliman
- Department of Pediatrics, Center of Pediatric Nephrology & Transplantation, Cairo University, Cairo, Egypt
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23
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Levin M, Steinhardt GF, Barber TD. Dermoid Cyst in a Multicystic Dysplastic Kidney: A Case Report and Literature Review. Urology 2015; 86:1001-3. [DOI: 10.1016/j.urology.2015.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/03/2015] [Accepted: 08/18/2015] [Indexed: 11/28/2022]
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Mashat SD, El-Desoky SM, Abdulaziz Kari J. Outcome of Multi-Cystic Dysplastic Kidneys in Children. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2991. [PMID: 26495094 PMCID: PMC4610334 DOI: 10.5812/ijp.2991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/02/2015] [Indexed: 11/17/2022]
Abstract
Background: Renal cystic diseases are important causes of chronic kidney disease (CKD). Objectives: We report the pattern of renal cystic disease in children and evaluate the outcome of children with multicystic dysplastic kidney (MCDK). Patients and Methods: Retrospective study of all children with cystic kidney diseases at King Abdulaziz University hospital from 2006 to 2014. Results: Total of 55 children (30 males); 25 MCDK, 22 polycystic kidney diseases (PKD), 4 nephronophthises and 4 renal cysts. Consanguinity was positive in 96.2%. MCDK and simple renal cyst patients had good renal function while PKD and nephronophthisis developed renal impairment. Most MCKD were diagnosed ante-natally, 16 of them were followed up for 3.4 (1.97) year. Their last creatinine was 33.9 (13.5) umol/L. MCDK was spontaneously involuted at mean age of 2.6 (1.3) years in 56%. Conclusions: MCDK is the commonest cystic renal disease and diagnosed ante-natally in the majority of cases. It has a good prognosis.
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Affiliation(s)
- Suleiman D. Mashat
- Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Sherif M. El-Desoky
- Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jameela Abdulaziz Kari
- Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Corresponding author: Jameela Abdulaziz Kari, Department of Pediatrics, King Abdulaziz University Hospital, P. O. Box: 80215, Jeddah, Kingdom of Saudi Arabia. Tel: +996-5056779048, Fax: +996-126408339, E-mail:
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Ultrasound diagnosis of multicystic dysplastic kidney: is a confirmatory nuclear medicine scan necessary? J Pediatr Urol 2014; 10:1059-62. [PMID: 24909606 DOI: 10.1016/j.jpurol.2014.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with severe hydronephrosis as the treatment varies significantly. We designed a study to compare renal ultrasound (RUS) to nuclear medicine (NM) scan in the diagnosis of MCDK, in order to determine if RUS can be used for the definitive diagnosis of MCKD without use of NM scan. MATERIALS AND METHODS We performed a retrospective review of children with MCDK, who underwent both a RUS and Tc-99m MAG3 or DMSA scan. We planned to calculate the positive predictive value of an RUS diagnosis of MCDK, using NM scan diagnosis of a nonfunctioning kidney as the gold standard. RESULTS The diagnosis of MCDK was made by RUS in 91 patients, 84 of whom had a normal bladder US. NM confirmed the diagnosis of MCDK in all 84 of these patients (100%). CONCLUSION We have demonstrated a high predictive value for RUS in the diagnosis of MCDK. Our data support that in healthy infants with RUS diagnosis of unilateral MCDK and normal bladder US, NM scan may be unnecessary to confirm the diagnosis.
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Multicystic dysplastic kidney: Impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol 2014; 10:645-9. [PMID: 24731390 DOI: 10.1016/j.jpurol.2014.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/18/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the impact of imaging modalities on the evaluation and prognosis of children with multicystic dysplastic kidney (MCDK) disease. PATIENTS AND METHODS A retrospective analysis of all children with MCDK diagnosed from 2004 until 2012 was performed. The study included 63 patients for whom all postnatal imaging modalities were available: renal bladder ultrasound (RBUS), dimercaptosuccinic acid scan (DMSA) and voiding cystourethrogram (VCUG). Cases with major congenital abnormalities or incomplete data were excluded. Abnormalities in the contralateral kidney and the fate of MCDK were also addressed. RESULTS At diagnosis, the average age was four-and-a-half months. The majority of cases were detected antenatally (87%). Postnatal RBUS and DMSA scans established the diagnosis of MCDK in 92% and 98% of patients, respectively. DMSA showed photopenic areas in the contralateral kidneys in 10% of patients; all of them had hydronephrosis and were confirmed to have vesicoureteral reflux (VUR). Contralateral VUR was detected in 16 patients; 63% of them had hydronephrosis. After a mean follow-up of three-and-a-half years, involution occurred in 62% of patients and the involution rate was inversely proportional to the initial size. CONCLUSIONS The classical appearance of MCDK on RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered.
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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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Hsu PY, Yu CH, Lin K, Cheng YC, Chang CH, Chang FM. Prenatal diagnosis of fetal multicystic dysplastic kidney in the era of three-dimensional ultrasound: 10-year experience. Taiwan J Obstet Gynecol 2012; 51:596-602. [DOI: 10.1016/j.tjog.2012.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 10/27/2022] Open
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Phillips GS, Paladin A. Essentials of genitourinary disorders in children: imaging evaluation. Semin Roentgenol 2011; 47:56-65. [PMID: 22166231 DOI: 10.1053/j.ro.2011.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace S Phillips
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA.
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Featherstone N, Boddy SA, Murphy FL. Indications and relative renal function for paediatric nephrectomy over a 20-year period. Pediatr Surg Int 2011; 27:1227-31. [PMID: 21953522 DOI: 10.1007/s00383-011-2975-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The indications for partial or total nephrectomy for urological reasons are not clearly documented in the paediatric surgical literature and there are only a limited number of publications on this subject. PURPOSE In order to clarify the situation in our centre, we reviewed our own indications for nephrectomy over a 20-year period. METHODS Medical records of patients who underwent nephrectomy for urological and oncological causes between May 1990 and October 2010 at our centre were retrospectively reviewed. Indications for nephrectomy were noted. Renal function was noted for urological cases. RESULTS A total of 357 nephrectomies were undertaken; out of these, 241 cases were for urological causes and 116 for oncological reasons. The majority of total nephrectomies were performed for multicystic dysplastic kidneys, reflux nephropathy, pelvi-ureteric junction obstruction and dysplasia. Eighty-seven patients exhibited no function at the time of nephrectomy. Of the remainder, 17 had <5% function, 18 had 5-10% function, 5 had 10-15% function and 2 patients had 15-20% function. CONCLUSIONS This is the largest series of nephrectomies in the paediatric surgery literature to date. The majority of nephrectomies were undertaken for urological conditions with relative renal function of <10% and could not have been usefully preserved in situ. We suggest that kidneys with >10% function should not be routinely removed.
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Kalisvaart J, Bootwala Y, Poonawala H, Elmore J, Kirsch A, Scherz H, Jones R, Grattan-Smith JD, Smith E. Comparison of Ultrasound and Magnetic Resonance Urography for Evaluation of Contralateral Kidney in Patients With Multicystic Dysplastic Kidney Disease. J Urol 2011; 186:1059-64. [DOI: 10.1016/j.juro.2011.04.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan Kalisvaart
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Yasmin Bootwala
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Husain Poonawala
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - James Elmore
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Andrew Kirsch
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Hal Scherz
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Richard Jones
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - J. Damien Grattan-Smith
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
| | - Edwin Smith
- Emory University School of Medicine (JK, YB, JE, AK, HS, ES) and Children's Healthcare of Atlanta (JE, AK, HS, RJ, JDG-S, ES), Atlanta, Georgia
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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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Hollowell JG, Kogan BA. How Much Imaging is Necessary in Patients With Multicystic Dysplastic Kidneys? J Urol 2011; 186:785-6. [DOI: 10.1016/j.juro.2011.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Barry A. Kogan
- Division of Urology, Albany Medical College, Albany, New York
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Psooy K. Multicystic dysplastic kidney in the neonate: the role of the urologist. Can Urol Assoc J 2011; 4:95-7. [PMID: 20368889 DOI: 10.5489/cuaj.10022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Karen Psooy
- Division of Pediatric Urology, Winnipeg Children's Hospital, Winnipeg, MB
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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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Singh JK, Kanojia RP, Narasimhan KL. Multicystic dysplastic kidney in children--a need for conservative and long term approach. Indian J Pediatr 2009; 76:809-12. [PMID: 19381503 DOI: 10.1007/s12098-009-0117-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 12/05/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We retrospectively studied our cases of Multicystic Dysplastic Kidney (MCDK). The review was aimed at identifying the pattern of the disease in Indian Scenario and the required management thereof. METHODS We studied the clinical, radiological and nuclear scan findings of 22 patients with unilateral MCDK. They were diagnosed and/or treated in our unit from 1999 to 2007. The diagnosis was achieved by Ultrasound and further confirmed by DMSA scans. Other ancillary investigations like Micturating cystourethrogram were done if indicated. These patients were followed and followup investigations consisted of renal ultrasound, blood pressure measurement, and urinalysis and blood biochemistry RESULTS A total of 22 patients (18 boys and 4 girls) with unilateral MCDK were investigated and followed for a mean period of 41 months. MCDK was detected on antenatal ultrasound only in 12(55%) and postnatally in 10(45%) babies. Mean age for postnatal diagnosis was 20 months. Follow up ultrasound revealed complete involution of MCDK in 3 patients and partial regression in 11 patients. The size of dysplastic kidney was unchanged in 4 patients and a further 4 patients underwent nephrectomy. Indications of nephrectomy were parental anxiety in 2, hypertension in 1 and palpable mass in 1. CONCLUSION Large proportion (45%) of patients in presented series are diagnosed post natally contrary to western world where more than 80% are diagnosed antenatally. Uncomplicated isolated MCDK carry good prognosis with nephrectomy required in only a few patients. Association with other urological anomalies in ipsilateral/contralateral genitourinary tract is important to identify as they have worse outcome in terms of ultimate renal function. All patients with simple/complex unilateral MCDK should be advised long term follow up for the possible development of hypertension and/or hyper infiltration injury.
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Affiliation(s)
- Jitendra Kumar Singh
- Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Hains DS, Bates CM, Ingraham S, Schwaderer AL. Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 2009; 24:233-41. [PMID: 18481111 DOI: 10.1007/s00467-008-0828-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 02/07/2023]
Abstract
In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5-43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19-73%, compensatory hypertrophy of the contralateral kidney occurs from 24-81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86-122 ml/min per 1.73 m(2) body surface area. Most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm. The risk of hypertension in those with MCDKs does not appear to be greater than that of the general population, and the rates of malignant transformation of MCDK are small, if at all increased, in comparison with those in the general population. If the patient develops a urinary tract infection or has abnormalities of the contralateral kidney, shown on ultrasound, a voiding cystourethrogram is recommended. Finally, the body of literature does not support the routine surgical removal of MCDKs.
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Affiliation(s)
- David S Hains
- Department of Pediatrics, Division of Pediatric Nephrology, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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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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Lim G, Lee JH, Park YS, Kim KS, Won HS. Incidence and outcome of congenital anomalies of the kidney and urinary tract detected by prenatal ultrasonography: a single center study. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gina Lim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kun Seok Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetric-Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bacchetta J, Liutkus A, Dodat H, Cochat P. [Multicystic dysplastic kidney disease: update and information for parents at the time of prenatal diagnosis]. Arch Pediatr 2008; 15:1107-15. [PMID: 18462928 DOI: 10.1016/j.arcped.2008.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 12/03/2007] [Accepted: 02/23/2008] [Indexed: 11/17/2022]
Abstract
Multicystic kidney disease (MCKD) is the most common form of Congenital Abnormality of Kidney and Urinary Tract (CAKUT). This anomaly of renal development is characterized by unilateral enlarged cystic formations and fibrous dysplastic parenchyma. The long-term prognosis is usually good; however because of reduced nephron mass, an early prevention of cardiovascular risk and nephrotoxicity is recommended. A lifelong follow-up of blood pressure, serum creatinine and microalbuminuria seems logical as well as in other patients with a single kidney. MCKD is usually diagnosed during pregnancy so that parents often question about long-term prognosis and follow-up. Therefore, we propose an information sheet for parents.
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Affiliation(s)
- J Bacchetta
- Département de pédiatrie, hôpital Edouard-Herriot, université Lyon-1,5, place d'Arsonval 69437 Lyon, France
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