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Unilateral multicystic dysplastic kidney: long term outcomes
1Children & Young People's Kidney Unit, Nottingham University Hospitals, Nottingham, UK.
Insights
Most unilateral multicystic dysplastic kidneys (MCDK) involute over time, with 59% gone by age 10. Long-term follow-up is recommended for remaining renal tissue and impaired function, with conservative management generally justified.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Antenatally detected unilateral multicystic dysplastic kidney (MCDK) is a common congenital anomaly.
- Long-term outcomes and involution patterns of MCDK require further elucidation.
Purpose of the Study:
- To assess the long-term follow-up of children diagnosed with unilateral MCDK before birth.
- To document complications, the rate of involution over time, and renal function at 10 years of age.
Main Methods:
- Prospective data from a regional registry of MCDK patients (1985-2004) were analyzed.
- Children underwent serial ultrasound scans (USS) at 2, 5, and 10 years.
Main Results:
- Complete involution of MCDK kidneys was observed in 33% by 2 years, 47% by 5 years, and 59% by 10 years.
- No significant complications like hypertension, proteinuria, or malignancy were noted. Two patients developed obstruction in the contralateral kidney.
- 19% of children had vesicoureteric reflux (VUR) into the contralateral kidney, without increased risk of UTIs or renal scarring. Mean GFR at 10 years was 86.4 ml/min/1.73 m2.
Conclusions:
- Conservative management with clinical review and infrequent USS is appropriate for unilateral MCDK.
- Continued follow-up is necessary for the 41% with persistent renal remnants and those with impaired GFR.
- Micturating cystography can be deferred unless ultrasound reveals abnormalities in the contralateral kidney or ureter.
Aims:
To report the long term follow up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) with documentation of complications, involution rate with time, and renal function at 10 years.
Methods:
Data were retrieved from a prospective regional registry of patients with MCDK between 1985 and 2004. Children were followed using a common protocol of investigation with follow up ultrasound scans (USS) at 2 (165 patients), 5 (117 patients), and 10 years (43 patients).
Results:
Serial USS showed that 33% of the MCDK kidneys had completely involuted at 2 years of age, 47% at 5 years, and 59% at 10 years. No patients developed hypertension, significant proteinuria, or malignancy, but two developed pelviureteric junction obstruction in the contralateral kidney. Twenty seven of 143 children (19%) had vesicoureteric reflux (VUR) (96% mild to moderate VUR) into the contralateral kidney with no difference in the incidence of urinary tract infections or renal scarring between those with or without VUR. The mean estimated glomerular filtration rate (GFR) was 86.4 ml/min/1.73 m2 (range 48-125) in 31 of 43 patients followed to 10 years.
Conclusions:
Conservative management of unilateral MCDK is justified with clinical review and infrequent USS but longer term follow up continues in the 41% still with renal remnants at 10 years and those with impaired GFR. It is suggested that the initial micturating cystogram is deferred unless abnormal USS features are present in the contralateral kidney or ureter.
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