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Contralateral vesicoureteral reflux in children with a multicystic kidney
1Department of Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University, School of Medicine, Cleveland, Ohio.
Insights
Children with multicystic kidney disease have a higher risk of contralateral vesicoureteral reflux. A voiding cystourethrogram is recommended for early detection and management of this condition.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Multicystic kidney (MCK) is frequently diagnosed via prenatal ultrasound.
- Children with MCK face an elevated risk of associated renal abnormalities.
- Contralateral renal anomalies require thorough investigation in pediatric patients.
Purpose of the Study:
- To ascertain the incidence of contralateral vesicoureteral reflux (VUR) in children diagnosed with MCK.
- To evaluate the necessity of voiding cystourethrogram (VCUG) in the diagnostic workup of MCK.
- To analyze risk factors and outcomes associated with contralateral VUR in this population.
Main Methods:
- A cohort of 65 children with newly diagnosed MCK underwent VCUG.
- Data collected included patient demographics, VUR presence and grade, and treatment outcomes.
- Follow-up assessments monitored VUR resolution and urinary tract infection (UTI) incidence.
Main Results:
- 15% of children with MCK were diagnosed with contralateral VUR.
- White children exhibited a significantly higher incidence of VUR (22%) compared to nonwhite children (4%).
- Antimicrobial prophylaxis prevented UTIs in all patients; higher-grade VUR showed varied resolution or required surgical intervention.
Conclusions:
- A substantial percentage of white children with MCK present with contralateral VUR.
- VCUG is a critical diagnostic tool for identifying contralateral VUR in children with MCK.
- Early detection and management, including antimicrobial prophylaxis, are crucial for preventing complications.
Abstract:
Multicystic kidneys are commonly diagnosed today due to the widespread use of prenatal ultrasound. Children with a multicystic kidney are at increased risk of contralateral renal abnormalities. We performed a voiding cystourethrogram on 65 children with a newly diagnosed multicystic kidney to determine the incidence of contralateral vesicoureteral reflux. Ten children (15%) with a multicystic kidney had contralateral vesicoureteral reflux, including 8 of 37 boys (22%) and 2 of 28 girls (7%). Contralateral reflux occurred in significantly more white (22%) than nonwhite (4%) patients (p < 0.001). Reflux was grade I in 2 children, II in 2, III in 2, IV in 1 and V in 3. All children were placed on antimicrobial prophylaxis. During a mean followup of 3.1 years grades I and II reflux resolved. Grade III reflux resolved in 1 child and remained stable in 1. Grade IV reflux was downgraded to III in 1 child on prophylaxis. One child with grade V reflux was stable on prophylaxis while the remaining 2 patients underwent ureteroneocystostomy. No child had a urinary tract infection. A significant proportion of white children with a multicystic kidney have contralateral vesicoureteral reflux and initial imaging should include a voiding cystourethrogram.