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.