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[Therapeutic attitude in patients with multicystic dysplastic kidneys]
J A Navascués del Río1, R Luque Mialdea, J Cerdá Berrocal
1Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
This study reviews seven pediatric multicystic dysplastic kidney (MCDK) cases over 15 years. Management varied, including nephrectomy for symptomatic cases and observation for others, highlighting diverse MCDK presentations.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Case Studies
Background:
- Multicystic dysplastic kidney (MCDK) is a common congenital anomaly of the kidney and urinary tract.
- Diagnosis can occur prenatally or postnatally, necessitating varied management strategies.
- Understanding long-term outcomes and optimal treatment is crucial for pediatric patients.
Purpose of the Study:
- To review the clinical presentation, management, and outcomes of pediatric MCDK cases.
- To analyze the indications for nephrectomy versus conservative management.
- To identify associated genitourinary anomalies in MCDK patients.
Main Methods:
- Retrospective case series of seven pediatric patients with MCDK treated over 15 years.
- Review of medical records including diagnostic imaging (ultrasound), clinical symptoms, and treatment decisions.
- Analysis of surgical interventions (nephrectomy) and non-operative management.
Main Results:
- Seven cases of MCDK were identified, with diagnosis in four prenatally and three postnatally.
- Three patients had contralateral upper urinary tract anomalies.
- Five nephrectomies were performed: two for neonatal abdominal masses, two for symptomatic urinary tract infections, and one for persistent MCDK.
- Two cases were managed non-operatively, one with partial regression and family refusal of surgery.
- Follow-up was lost in one non-operatively managed patient.
Conclusions:
- Multicystic dysplastic kidney (MCDK) management in children is individualized based on presentation and associated anomalies.
- Nephrectomy is indicated for symptomatic cases, including abdominal masses and recurrent infections.
- Conservative management may be an option for select cases, though long-term follow-up is essential.
Abstract:
We presented seven multicystic dysplastic kidney cases treated in our Hospital during the last 15 years. Four children were diagnosed prenatally and three during the first term of life. Five were girls and two boys. We found three contralateral upper urinary tract anomalies. We did five nephrectomies. In two cases because compressive abdominal mass during the neonatal period, in two cases during the first year of life because symptomatic urinary tract infections and one case at the age of 13 months with persistent multicystic dysplastic kidney followed by ultrasound. Two cases were not operated. In one patient with partial regression of the multicystic kidney the family refused operation. We have lost follow-up in the last patient.