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Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary?

Adam C Calaway1, Benjamin Whittam, Konrad M Szymanski

  • 1Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana, USA.

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|October 28, 2014
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Summary
This summary is machine-generated.

Routine voiding cystourethrograms (VCUG) may not be necessary for healthy children with unilateral multicystic dysplastic kidney (MCDK). A low incidence of clinically significant vesicoureteral reflux (VUR) was observed, questioning the routine use of VCUG in these patients.

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Area of Science:

  • Pediatric Urology
  • Nephrology
  • Diagnostic Imaging

Background:

  • Traditionally, voiding cystourethrogram (VCUG) is performed in patients with multicystic dysplastic kidney (MCDK) due to reported vesicoureteral reflux (VUR) rates of 10-20%.
  • Changes in the diagnosis and management of low-grade VUR prompt re-evaluation of the utility of VCUG in healthy children with MCDK.

Purpose of the Study:

  • To assess the necessity of routine VCUG in healthy children diagnosed with unilateral MCDK.
  • To determine the rate of clinically significant VUR requiring intervention in this patient population.

Main Methods:

  • Retrospective review of children diagnosed with unilateral MCDK between 2002 and 2012 who underwent VCUG.
  • Analysis of VUR incidence, surgical intervention rates, and predictors of VUR.

Main Results:

  • Out of 133 patients, VUR was identified in 17.3% (23 children).
  • Only 3.0% (4 patients) required surgical intervention for VUR (due to UTIs, scarring, or non-resolution).
  • Contralateral hydronephrosis was not predictive of VUR.

Conclusions:

  • Routine VCUG may not be warranted in healthy children with unilateral MCDK due to the low incidence of clinically significant VUR.
  • A conservative approach, potentially withholding routine VCUG in select cases (e.g., without normal kidney hydronephrosis), may be considered.
  • Families should be educated on UTI signs and symptoms if VCUG is not performed.