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Outcome of children with multicystic dysplastic kidney: Does involved side matter?
Sevgi Yavuz1, Aysel Kıyak1, Serdar Sander2
1Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Insights
Children with multicystic dysplastic kidney (MCDK) face renal deterioration risks. Hypertension is a key factor for chronic kidney disease (CKD) progression in these patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Multicystic dysplastic kidney (MCDK) is a common congenital kidney anomaly.
- Antenatal ultrasound frequently detects MCDK, necessitating further evaluation of affected children.
Purpose of the Study:
- To characterize the clinical profile of children diagnosed with MCDK.
- To determine if the laterality of MCDK impacts patient outcomes.
Main Methods:
- A cohort of 39 MCDK patients and 20 controls were analyzed.
- Patient eGFR values were assessed, and comparisons were made between MCDK patients and controls, as well as between right-sided and left-sided MCDK cases.
Main Results:
- MCDK was equally distributed between right (51.3%) and left (48.7%) sides.
- Significant findings included contralateral kidney enlargement (82%), involution (48.7%), and complications such as UTI (35.8%), microalbuminuria (30%), hypertension (12.8%), and CKD progression (17.9%).
- Hypertension emerged as an independent risk factor for CKD, and patients showed decreased eGFR and increased cystatin C and microalbuminuria compared to controls. Right-sided MCDK showed higher cystatin C levels.
Conclusions:
- MCDK predisposes children to renal deterioration, even with initially normal eGFR.
- While right-sided MCDK showed higher cystatin C levels, laterality did not significantly affect overall renal outcomes.
- Hypertension is identified as the primary determinant for CKD progression in children with MCDK.
Background:
Multicystic dysplastic kidney (MCDK) is a common anomaly detected on antenatal ultrasound. We aimed to assess the profile of children with MCDK and to investigate whether the involved side has any effect on outcome.
Methods:
Thirty-nine patients with MCDK and 20 controls were enrolled. Patients who estimated glomerular filtration rate (eGFR) values over 90 mL/min/1.73 m2 were compared with controls. Comparison was made between the involved sides.
Results:
MKDB was right-sided in 20 (51.3%) and left-sided in 19 (48.7%) patients. 33.3% had additional urinary tract abnormality, 10.2% had systemic abnormality. 82% showed contralateral kidney enlargement. 48.7% involuted, 17.9% underwent nephrectomy. 35.8% suffered from urinary tract infection (UTI). 5.1% had renal scarring (RS). 30% developed microalbuminuria. 12.8% complicated with hypertension. 17.9% progressed to chronic kidney disease (CKD). Hypertension was independent risk factor for developing CKD. Blood pressure, cystatin C and urine microalbumin/creatinine levels were increased, and eGFR values were decreased in patients compared to controls. No significant difference was found between the two sides for rates of involution, UTI, RS, nephrectomy, and additional abnormality. Cystatin C levels were higher on the right than left sides (p = .033).
Conclusion:
Children with MCDK predispose to renal deterioration even at normal eGFR values. Although cystatin C levels tended to increase in right-sided patients, the involved side seemed to have no significant effect on renal outcome. Hypertension was main determinant for progression to CKD in MCDK.
