Unilateral multicystic dysplastic kidney: long term outcomes

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.