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Published on: February 3, 2012
Multicystic dysplastic kidney
1Department of Pediatrics, Ohio State University College of Medicine, Columbus.
Insights
Multicystic kidney disease (MCDK) poses low direct risks to patients, but associated urinary tract issues require monitoring. Routine removal of MCDK is no longer recommended.
Area of Science:
- Pediatric Nephrology
- Urology
- Developmental Biology
Background:
- Multicystic kidney disease (MCDK) is a congenital anomaly.
- Understanding associated clinical risks is crucial for patient management.
- Previous approaches often involved prophylactic interventions.
Purpose of the Study:
- To analyze and assess clinical risks associated with MCDK.
- To re-evaluate the necessity of routine MCDK removal.
- To guide contemporary management strategies for MCDK.
Main Methods:
- Literature review and analysis of clinical risks.
- Assessment of risks to the patient, opposite kidney, and urinary tract.
- Consideration of family risks and long-term registry data.
Main Results:
- MCDK poses low direct risks (hypertension, infection, malignancy) to the patient.
- Increased risks are primarily to the contralateral kidney and lower urinary tract (obstruction, reflux).
- Family risks (current and future) are also a consideration.
Conclusions:
- Routine surgical removal of MCDK in young patients is not advisable.
- Long-term surveillance of MCDK itself may not be necessary, but associated urological abnormalities require follow-up.
- Periodic blood pressure screening is recommended for patients with MCDK.
Abstract:
The contemporary literature helps us to analyze and assess the various clinical risks associated with MCDK. Clearly, MCDK is not an isolated developmental anomaly, and the child born with MCDK is at increased risk, but these risks are primarily directed towards: (1) the opposite kidney and lower urinary tract, where there is a significant likelihood of coexisting obstructive disease and reflux, and (2) the patient's family (current and future). In contrast, the risks to the patient caused by the MCDK (hypertension, infection, or malignant degeneration) actually appear to be quite low. Consequently, it no longer seems advisable to routinely remove MCDK in young patients for either diagnostic or prophylactic reasons. Nor is it obvious to what degree the MCDK itself requires long-term surveillance, although associated urological abnormalities will need follow-up and the patient requires periodic blood pressure screening. Hopefully, by careful analysis of the risks to the patient and family, the results of non-operative management, and the long-term results of the Multicystic Kidney Registry, contemporary pediatric nephrologists, urologists and surgeons will be able to reassess their approach to the evaluation and clinical management of the patient with this condition.
