Hypertension and multicystic kidney

doi:10.1016/0090-4295(89)90443-3

Urology

Volume 34, Issue 6, December 1989, Pages 362-366

https://doi.org/10.1016/0090-4295(89)90443-3 Get rights and content

Abstract

The optimal management of the asymtomatic patient with a multicystic kidney remains a dilemma. The risk of nephrectomy in a neonate or infant with this lesion is small and the morbidity is minimal. The alternative to elective nephrectomy is life-long follow-up with blood pressure determinations, beginning in infancy. We report herein two infants with multicystic kidney (MCK) in whom hypertension was cured by its removal. Since accurate blood pressure measurements are relatively difficult to obtain in infants and since periodic long-term follow-up is difficult in the best of circumstances, we are concerned that hypertension caused by a retained MCK goes undiagnosed perhaps more frequently than a review of the current literature suggests. Such hypertension may result in contralateral renal damage and arteriosclerosis, so that later removal of the MCK may not have a beneficial effect on the elevated blood pressure.

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Cited by (43)

Systemic Hypertension
2023, Avery's Diseases of the Newborn
Identification of hypertension in neonates is challenging given the lack of robust normative data, the rapid changes in blood pressure that occur following delivery, and the multiple factors that may affect neonatal blood pressure. When a neonate is considered to have hypertension, a focused evaluation should enable identification of the likely underlying cause. Therapy is largely based on extrapolation for treatment of hypertension in older children, and on clinical experience. Many hypertensive neonates will resolve their hypertension over the first 6 to 12 months of life, although those with identified secondary causes may have persistent hypertension throughout childhood.
Evidence-based treatment of multicystic dysplastic kidney: a systematic review
2018, Journal of Pediatric Urology
Citation Excerpt :
Unfortunately, as all patient ages were not documented in the cohort studies, the age at which there is a maximal risk of hypertension with MCDK cannot be determined. There were a total of 10 case reports describing hypertension in 27 patients [4,20–23,26,31,55,65,66]. These were not included as it is difficult to quantitate the true value of these cases towards hypertension risk as the total population from which these cases are derived is unknown.
There is a lack of a standardised protocol for the investigation and non-operative management of paediatric multicystic dysplastic kidney (MCDK). Institutional protocols for non-operative management remain essentially ad hoc. The primary outcome of this systematic review is to establish the incidence of hypertension associated with an MCDK. The secondary outcome is to determine the malignancy risk associated with an MCDK. The tertiary outcome is to assess the rate of MCDK involution. Subsequent to these, an evidence-based algorithm for follow-up is described.
A systematic review of all relevant studies published between 1968 and April 2017 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified by specific inclusion and exclusion criteria, all of which included data relevant to the primary, secondary and tertiary outcomes. Hypertension was defined as systolic blood pressure greater than the 95th centile for gender, age and height centile. Subset analysis was performed for hypertension associated with an MCDK.
The primary outcome measure revealed a 3.2% (27/838) risk of developing hypertension associated with an MCDK. The secondary outcome measure noted a 0.07% malignancy risk (2/2820). The tertiary outcome measure established that 53.3% (1502/2820) had evidence of involution of the dysplastic kidney. A total of 44 cohort studies (2820 patients) were analysed.
Given the low risk of hypertension and malignancy, which is similar to the general population, the current conservative non-operative pathway is an appropriate management strategy. An algorithm to help support clinicians with ongoing management is proposed.
Neonatal Hypertension
2018, Avery's Diseases of the Newborn: Tenth Edition
- •
  There are numerous influences on normal blood pressure in neonates, including gestational age, birthweight, and maternal factors such as preeclampsia. This makes it difficult to define normal and abnormal blood pressure (BP).
- •
  As in older children, identification of hypertension (HTN) in the neonate is dependent on correct BP measurement technique.
- •
  While the differential diagnosis of systemic HTN in the neonate is broad, common causes include catheter-related thromboembolic phenomena, chronic lung disease, kidney disease, and iatrogenic causes. A focused diagnostic evaluation should lead to correct identification of the underlying cause in most neonates.
- •
  Therapy for HTN in the neonate is largely empiric because of a lack of data on outcomes of elevated BP in neonates and exclusion of neonates from antihypertensive drug trials.
Neonatal Hypertension
2017, Avery's Diseases of the Newborn, Tenth Edition
- •
  There are numerous influences on normal blood pressure in neonates, including gestational age, birthweight, and maternal factors such as preeclampsia. This makes it difficult to define normal and abnormal blood pressure (BP).
- •
  As in older children, identification of hypertension (HTN) in the neonate is dependent on correct BP measurement technique.
- •
  While the differential diagnosis of systemic HTN in the neonate is broad, common causes include catheter-related thromboembolic phenomena, chronic lung disease, kidney disease, and iatrogenic causes. A focused diagnostic evaluation should lead to correct identification of the underlying cause in most neonates.
- •
  Therapy for HTN in the neonate is largely empiric because of a lack of data on outcomes of elevated BP in neonates and exclusion of neonates from antihypertensive drug trials.
Nephrectomy for hypertension in pediatric patients with a unilateral poorly functioning kidney: A contemporary cohort
2011, Journal of Pediatric Urology
Citation Excerpt :
Approximately 60–80% of secondary hypertension in childhood is caused by renal parenchymal disease [1]. Unilateral renal parenchymal diseases, including MCKD, have been reported causes of hypertension in children [9,15,16]. Undertreated or untreated hypertension in children can have serious sequelae including cardiovascular disease [17] and chronic renal insufficiency [18].
A unilateral poorly or non-functioning kidney is a cause of hypertension in children. We report the outcomes of pediatric patients with unilateral renal parenchymal disease who underwent nephrectomy for hypertension.
Consecutive hypertensive children undergoing nephrectomy with a unilateral poorly or non-functioning kidney were retrospectively reviewed; preoperative and postoperative clinical variables were analyzed.
From July 2002 to August 2009, 21 patients (8M:13F) with average age 3.5 years and average follow-up 17.8 months were studied. Eleven patients had multicystic dysplastic kidney, 8 had reflux nephropathy, and 2 had ureteropelvic junction obstruction. Fourteen of 21 (67%) had blood pressure normalization after nephrectomy. Seven of 11 with MCDK were normotensive postoperatively compared to 6/8 patients with reflux nephropathy, and 1/2 patients with UPJ obstruction. Of the 14 patients normotensive postoperatively, 7 were on antihypertensives prior to surgery. Four of 7 patients stopped their anti-hypertensive medications postoperatively, 2 decreased from 3 and 4 medications to 1, and 1 remained on an ACE inhibitor. There were 2 patients with contralateral renal scarring, both of which remained hypertensive postoperatively.
Nephrectomy in hypertensive pediatric patients with a unilateral poorly functioning or non-functioning kidney yielded hypertension resolution in 67% (14/21), permitting cessation or diminution of antihypertensives in many patients. Given the alternative of lifelong antihypertensives with the risk of medication non-compliance and side-effects, nephrectomy is a logical option of care which can be offered to patients and families with informed knowledge of the potential for cure.
Multicystic Dysplastic Kidney Disease
2010, Pediatric Urology

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Hypertension and multicystic kidney

Abstract

J Urol

J Urol

Urology

J Pediatr Surg

Radiol Clin North Am

J Urol

J Urol

J Urol

J Urol

J Urol

The multicystic kidney

J Urol