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Multicystic dysplastic kidney: Impact of imaging modality selection on the initial management and prognosis
O M Sarhan1, M Alghanbar1, A Alsulaihim1
1Pediatric Urology Unit, Urology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Insights
Renal bladder ultrasound (RBUS) and dimercaptosuccinic acid (DMSA) scans effectively diagnose multicystic dysplastic kidney (MCDK) in children. DMSA scans are more accurate for evaluating the contralateral kidney and detecting vesicoureteral reflux (VUR).
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Congenital Abnormalities
Background:
- Multicystic dysplastic kidney (MCDK) is a common congenital anomaly.
- Accurate diagnosis and prognosis are crucial for pediatric kidney disease management.
Purpose of the Study:
- To evaluate the impact of imaging modalities on the diagnosis and prognosis of pediatric MCDK.
- To assess the role of renal bladder ultrasound (RBUS), dimercaptosuccinic acid (DMSA) scan, and voiding cystourethrogram (VCUG) in MCDK evaluation.
Main Methods:
- Retrospective analysis of 63 children diagnosed with MCDK between 2004 and 2012.
- Inclusion of postnatal RBUS, DMSA, and VCUG data.
- Exclusion of cases with major congenital abnormalities or incomplete data.
Main Results:
- RBUS and DMSA confirmed MCDK diagnosis in 92% and 98% of patients, respectively.
- DMSA identified contralateral kidney abnormalities in 10% of patients, all with hydronephrosis and vesicoureteral reflux (VUR).
- Involution of MCDK occurred in 62% of patients over a mean follow-up of 3.5 years, inversely proportional to initial size.
Conclusions:
- RBUS is sufficient for initial MCDK diagnosis, while DMSA offers superior diagnostic accuracy and contralateral kidney evaluation.
- Selective VUR screening is recommended for patients with contralateral hydronephrotic kidneys.
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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