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Unilateral multicystic dysplastic kidney: experience in children
E Kuwertz-Broeking1, O A Brinkmann, H J Von Lengerke
1Department of Paediatric Nephrology, University Children's Hospital, Westphalian-Wilhelms University of Münster, Germany. broeking@uni-muenster.de
BJU International
|February 7, 2004
Summary
Multicystic dysplastic kidney (MCDK) in children often resolves spontaneously or shrinks, with few requiring intervention. Routine voiding cysto-urethrography is unnecessary if ultrasonography shows a normal contralateral kidney and urinary tract.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Unilateral multicystic dysplastic kidney (MCDK) is the most common renal cystic disease in children.
- Associated malformations of the contralateral urinary tract and kidney are frequently reported.
Purpose of the Study:
- To evaluate the contralateral kidney and urinary tract in children with unilateral MCDK.
- To assess functional consequences, and urological and nephrological management outcomes.
- To determine the necessity of specific diagnostic tests and interventions.
Main Methods:
- Retrospective study of 97 children (60 boys, 37 girls) with unilateral MCDK diagnosed between 1985 and 1998.
- Diagnosis confirmed by ultrasonography (US), renal scanning, or intravenous urography.
- Voiding cysto-urethrography (VCUG) performed in 92% of patients; mean follow-up of 44.3 months.
Main Results:
- MCDK involution or shrinkage observed in 85% of cases; no malignancies detected.
- Contralateral kidney anomalies found in 20% of patients, primarily dilated renal pelvis and echogenicity changes.
- Only 4.5% of patients had reflux detected by VCUG; 5 children required surgery for contralateral urinary tract issues.
- 43% of contralateral kidneys showed compensatory hypertrophy; mild renal insufficiency and hypertension were noted in a few cases.
Conclusions:
- Ultrasonography (US) is effective for diagnosing unilateral MCDK and contralateral anomalies.
- Renal scintigraphy is useful when US findings of the dysplastic kidney are uncertain.
- Routine VCUG is not necessary if contralateral US is normal; nephrectomy of MCDK is often unnecessary.
- Long-term nephro-urological follow-up is recommended for children with MCDK.