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Hypertension and multicystic kidney
M R Susskind1, K S Kim, L R King
1Division of Urology, Duke University Medical Center, Durham, North Carolina.
Insights
Management of asymptomatic multicystic kidney (MCK) in infants is challenging. Surgical removal of MCK cured hypertension in two infants, suggesting nephrectomy may be preferable to long-term monitoring for these patients.
Area of Science:
- Pediatric Nephrology
- Surgical Management of Renal Lesions
Background:
- The optimal management for asymptomatic multicystic kidney (MCK) in infants is debated.
- Nephrectomy in infants carries minimal risk and morbidity.
- Long-term surveillance with blood pressure monitoring is an alternative to surgery.
Observation:
- Two infants with MCK experienced hypertension.
- Hypertension was resolved after surgical removal of the MCK.
- Accurate infant blood pressure measurement and long-term follow-up are challenging.
Findings:
- Surgical intervention for MCK can effectively cure associated hypertension in infants.
- Delayed diagnosis of MCK-induced hypertension due to monitoring difficulties is a concern.
- Retained MCK can lead to contralateral renal damage and arteriosclerosis.
Implications:
- Early nephrectomy for MCK may be a more effective strategy than conservative management in preventing hypertension-related complications.
- Undiagnosed hypertension from retained MCK can have severe long-term consequences.
- This study highlights the importance of considering MCK as a cause of hypertension in infants.
Abstract:
The optimal management of the asymptomatic patient with a multicystic kidney remains a dilemma. The risk of nephrectomy in a neonate or infant with this lesion is small and the morbidity is minimal. The alternative to elective nephrectomy is life-long follow-up with blood pressure determinations, beginning in infancy. We report herein two infants with multicystic kidney (MCK) in whom hypertension was cured by its removal. Since accurate blood pressure measurements are relatively difficult to obtain in infants and since periodic long-term follow-up is difficult in the best of circumstances, we are concerned that hypertension caused by a retained MCK goes undiagnosed perhaps more frequently than a review of the current literature suggests. Such hypertension may result in contralateral renal damage and arteriosclerosis, so that later removal of the MCK may not have a beneficial effect on the elevated blood pressure.