Pediatric urologyNephrectomy for multicystic dysplastic kidney: if and when?☆
Section snippets
Material and methods
Since 1989, a primarily conservative approach in the treatment of MDK has been adopted at the Hospital for Children and Adolescents, University of Helsinki. The study population comprised 48 consecutive patients with MDK treated between 1989 and 1999 at our institution.
MDK was defined as a renal tissue conglomerate, ultrasonographically consisting of cysts of variable size, with scanty or no identifiable renal parenchyma in between, and with no uptake on renal isotope scanning. MDK of the
Results
Complete involution of the multicystic conglomerate was observed by ultrasonography in 13 (27%) of the 48 patients. In 12 of the 13, involution occurred within 24 months, and in 1, it occurred at 51 months (median 14) of age. One patient with a conglomerate size of 7.5 cm at birth and a decrease to 2.2 cm at 36 months old was being followed up expectantly at the end of the study. Of the 32 patients who eventually underwent surgery, a reduction in the size of the cysts was observed in 19 (59%)
Comment
Our treatment plan was to follow-up our patients with MDK expectantly and to decide on nephrectomy after a follow-up period of a minimum of 18 months. The indication for surgery was an increased, unchanged, or only moderately decreased conglomerate size during the follow-up period. Consequently, 32 (67%) of the total of 48 patients eventually underwent surgery, 23 (72%) of these 32 within 30 months of follow-up.
Great variation in the prevalence of involution of affected units in MDK has been
Conclusions
Patients with antenatally or neonatally detected MDK can primarily be followed up conservatively. Involution within a reasonably acceptable time limit can be expected to occur in approximately one fourth of cases. In the remaining cases, usually no significant involution occurs after 18 months of age. Hence, if surgery is decided on, we recommend an age of about 2 years. Late complications (eg, Wilms' tumor and renal hypertension) are rare. Their significance in decision-making should not be
References (18)
- et al.
Multicystic dysplastic kidneyis nephrectomy still appropriate?
J Urol
(1988) - et al.
Wilms tumor and multicystic dysplastic kidney disease
J Urol
(1997) - et al.
Report of the multicystic kidney registrypreliminary findings
J Urol
(1993) Hypertension associated with multicystic dysplastic kidney in children
J Urol
(2000)Renal dysplasiathe risks and consequences of leaving dysplastic tissue in situ
Urology
(1998)- et al.
Outcome and cost analysis of operative versus nonoperative management of neonatal multicystic dysplastic kidneys
J Urol
(1998) - et al.
Transitional cell carcinoma in a multicystic dysplastic kidney
J Urol
(2000) - et al.
Increased risk of multicystic dysplastic kidney among babies of both pre-gestational and gestational diabetic mothers
Eur J Pediatr
(2002) - et al.
Involution rate of multicystic renal dysplasia
Pediatrics
(1998)
Cited by (23)
Evidence-based treatment of multicystic dysplastic kidney: a systematic review
2018, Journal of Pediatric UrologyCitation Excerpt :Some centres used different centiles or older blood pressure reports, the European blood pressure report, or used an ambulatory blood pressure monitor [4,17–31]. Twenty-one articles did not define hypertension [5,32–50]. In the systematic review, 41 of the 44 cohort studies included data on the incidence of hypertension in paediatric patients [10,11,13,16–19,24,25,27,29,30,32–35,37,46–48,50–54].
Dermoid Cyst in a Multicystic Dysplastic Kidney: A Case Report and Literature Review
2015, UrologyCitation Excerpt :Tiryaki et al reported 1 patient with hypertension out of 63.6 No patient had hypertension out of 48 in another report.12 Similar results were reported in Onal and Kogan's series of 61 patients as well as Chiappinelli et al's series of 50 patients.3,4
Multicystic dysplastic kidney: Impact of imaging modality selection on the initial management and prognosis
2014, Journal of Pediatric UrologyCitation Excerpt :In the present study's group of patients, two developed CKD after a mean follow up of three-and-a-half years. It has been agreed upon by many authors that most patients with MCDK will not require any sort of intervention, as most of the cases tend to involute over time with the fastest rates during early life [3,4,6,7,23]. In many studies, the rate of involution varies from 20 to 75% [3,4,6,7,24,25].
Current Diagnosis and Management of Fetal Genitourinary Abnormalities
2007, Urologic Clinics of North AmericaUltrasound progression of prenatally detected multicystic dysplastic kidney
2006, UrologyCitation Excerpt :In a series of 18 children with MCDK who underwent serial ultrasound scans, White et al.2 showed that in 7 kidneys that decreased in size, the mean rate was 0.38 cm/yr (SD 0.21) but for the 4 kidneys that involuted completely, the mean rate was 1.02 cm/yr (SD 0.287). Recently, in a series of 48 antenatally or neonatally detected unilateral MCDKs, Ylinen et al.13 identified two distinct patterns related to sonographic involution after a minimal follow-up period of 18 months. Complete involution of MCDKs was observed in 13 (27%) of the 48 patients, with a mean involution rate of 2.5 cm/yr (between 0 and 18 months).
Genitourinary Imaging Techniques
2006, Pediatric Clinics of North America
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This study was financially supported by the Foundation for Pediatric Research, Helsinki, Finland and by the Medical Research Fund of Tampere University Hospital.