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Follow-up studies of multicystic dysplastic kidneys
L Vinocur1, T L Slovis, A D Perlmutter
1Department of Urology, Children's Hospital of Michigan, Detroit 48201.
Insights
Multicystic dysplastic kidney (MCDK) often resolves spontaneously. Surgical removal is typically unnecessary unless the kidney grows significantly in the first year, suggesting a need for longer follow-up.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Multicystic dysplastic kidney (MCDK) is a common congenital anomaly.
- Management strategies for MCDK vary, with surgical intervention (nephrectomy) being one option.
Purpose of the Study:
- To evaluate the natural history and outcomes of multicystic dysplastic kidney (MCDK).
- To determine the necessity of nephrectomy for classic and hydronephrotic MCDK.
Main Methods:
- Retrospective review of 30 multicystic dysplastic kidney (MCDK) cases diagnosed over 11 years.
- Analysis of patient follow-up data, including imaging (ultrasound) and clinical outcomes.
- Comparison of outcomes between patients who underwent nephrectomy and those managed conservatively.
Main Results:
- Nine patients (30%) underwent nephrectomy; three for classic MCDK with increasing size, six for hydronephrotic MCDK with inconclusive diagnosis.
- Of 21 conservatively managed patients, 16 MCDK lesions remained stable, one decreased in size, and two disappeared within 3 years.
- Associated conditions included non-renin-producing hypertension, nephroblastomatosis, and contralateral pyelonephritis.
Conclusions:
- Classic MCDK diagnosed via imaging may not require removal unless growth is observed in the first year.
- A significant percentage of MCDK lesions resolve spontaneously over time, supporting extended follow-up.
- Conservative management with prolonged observation is a viable option for many MCDK cases.
Abstract:
Thirty cases of multicystic dysplastic kidney (MCDK) were diagnosed over 11 years. Nine patients underwent nephrectomy: three for increasing kidney size (classic MCDK) and six because of an inconclusive diagnosis (hydronephrotic MCDK). Of the remaining 21 patients, 19 were followed up for a mean of 33.5 months (range, 2-101 months). Follow-up ultrasound examinations revealed that 16 kidneys did not change in size, one decreased in size after cyst puncture, and two disappeared (one after cyst puncture). This series included one case of non-renin-producing hypertension that was controlled medically, one case of nephroblastomatosis found in the removed dysplastic kidney, and one case of pyelonephritis in the contralateral kidney. When the diagnosis of classic MCDK is made with imaging modalities, the lesion may not have to be removed unless there is growth of the mass during the 1st year of life. Nine percent of these lesions will disappear within the first 3 years of follow-up, and the authors recommend an even longer period of follow-up.