Follow-up of unilateral multicystic kidney dysplasia after prenatal diagnosis

Abstract

This study provides evidence that neonatal nephrectomy of unilateral MCDK is rarely required. It also shows that the discussed malformation is not an isolated developmental abnormality. In a high proportion, associated urogenital abnormalities were present and therapeutically relevant, and determined the overall prognosis.

Unilateral multicystic dysplastic kidney: single-center experience

“…Contralateral VUR rate has been noted between 5% and 25.3% in previous reports [3, 14, 15, 25-27, 30, 32, 34-36, 38]. Therefore, some authors advocate that VCUG should be performed in all patients with MCDK to determine contralateral VUR [25,34,38]. According to other authors, routine VCUG was not necessary, because VUR was usually low grade when US assessment was normal [3,31,32,37,39].…”

“…VUR was low grade in six patients. [25] reported that only six (6.8%) of 88 children with MCDK had contralateral VUR. Those reports are similar to our study regarding the number of patients and the rate of VUR into the contralateral kidney.…”

“…As patients with MCDK have only one functioning kidney, abnormalities of the contralateral kidney directly affect the prognosis. Some reports recommend performing voiding cystourethrogram (VCUG) to investigate VUR into the contralateral kidney in all patients with MCDK, whereas the others advocate that routine VCUG is unnecessary [3,10,25,31,32]. The aim of this study was to evaluate the clinical course and outcome of our patients with MCDK to discuss the diagnostic approach, follow-up, and treatment of those patients.…”

“…Routine nephrectomy was performed in many centers to prevent those complications before 1990. However, according to recent reports, the necessity of routine nephrectomy is controversial [3,10,11,13,[23][24][25]. Moreover, MCDK is likely to be associated with additional abnormalities of the urogenital system, including vesicoureteral reflux (VUR) [26][27][28][29][30].…”

Multicystic dysplastic kidney in the neonate: the role of the urologist

“…Using only published reports of referred and live birth populations with MCDK where more than 90% of the patients with unilateral MCDK had a voiding cystogram, the percent with contralateral vesicoureteral reflux ranges from 4.5% to 28% (weighted mean 16%, total n = 889). 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] a. In select studies, [25][26][27][28][29] the presence of contralateral renal abnormalities (including dilatation of the collecting system, ectopia and agenesis, but excluding the absence of compensatory hypertrophy) documented on renal ultrasound conferred a risk of contralateral vesicoureteral reflux of 21.829 times more than those without (Chi-squared 56.705 with 1 degree of freedom, p < 0.0001).…”