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Ultrasonographic evaluation of multicystic dysplastic kidney
1Department of Radiology, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of China.
Insights
Multicystic dysplastic kidney (MCDK) in children presents in four patterns on ultrasound. Early diagnosis and recognition of associated anomalies are crucial for management.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Urology
Background:
- Multicystic dysplastic kidney (MCDK) is a common congenital renal malformation.
- Accurate prenatal and postnatal diagnosis is essential for appropriate management and to rule out other renal pathologies.
Purpose of the Study:
- To describe the diverse sonographic patterns of multicystic dysplastic kidney (MCDK) in children.
- To evaluate the diagnostic utility of postnatal ultrasound (US) in identifying MCDK.
- To investigate the incidence of contralateral renal anomalies in children with MCDK.
Main Methods:
- Retrospective analysis of 11 pediatric cases of MCDK diagnosed over 11 years.
- All cases underwent postnatal ultrasound (US) examinations.
- Correlation with other imaging modalities (intravenous urography, radionuclide study) and surgical findings.
Main Results:
- Four distinct sonographic patterns of MCDK were identified: classic multicystic, hydronephrotic form, evolving cystic changes, and isolated cysts without parenchyma.
- The hydronephrotic form posed diagnostic challenges, mimicking simple hydronephrosis.
- Contralateral renal anomalies, particularly ureteral stenosis, were observed in 5 out of 11 children, with a higher prevalence in the hydronephrotic MCDK group.
Conclusions:
- Postnatal ultrasound is highly beneficial for diagnosing MCDK, but careful differentiation from hydronephrosis is necessary.
- Recognizing the varied presentations of MCDK aids in accurate diagnosis and management planning.
- The high rate of associated contralateral anomalies underscores the importance of comprehensive evaluation in children with MCDK.
Abstract:
Eleven cases of multicystic dysplastic kidney (MCDK) in children were diagnosed over an 11 year period. All underwent postnatal ultrasound (US) studies. Four different patterns of MCDK were recognized: (1) Six cases presented with the classic sonogram of multicystic components. (2) Three cases had hydronephrotic form; correct diagnosis between hydronephrotic form of MCDK and hydronephrosis was difficult as there was a medially-located, large, lobulated cyst and there was connection between the large cyst and neighboring small cysts. (3) One case initially presented with normal renal sonogram but a small cyst appeared on follow up sonogram and there was also decreased renal size and increased echogenecity. (4) One case had only two moderate-sized cysts but no identifiable renal parenchyma. Two cases had follow-up US examination and one dysplastic kidney decreased in renal size on follow-up sonogram. Intravenous urography and radionuclide study revealed both these dysplastic kidneys to be nonfunctioning. Nine children had surgical resection of the diseased kidneys. Contralateral renal anomalies were detected in five children, which included ureteropelvic junction stenosis, ureterovesical junction stenosis, distal ureteral stenosis and polycystic kidney disease. Two of three hydronephrotic forms of MCDK had contralateral ureteral stenosis. Two of six classic forms of MCDK had contralateral ureteral stenosis. The proportion of contralateral ureteral stenosis was higher in the group of hydronephrotic forms of MCDK. Ultrasonography is beneficial for conclusive diagnosis of MCDK; however, a differential diagnosis of simple hydronephrosis needs to be considered.