Natural History of Patients With Multicystic Dysplastic Kidney—What Followup is Needed?
Abstract
Purpose:
Most clinicians recommend followup with annual ultrasound for patients with multicystic dysplastic kidney. The aim of this study was to determine whether followup ultrasound provides any clinical benefit.
Materials and Methods:
We retrospectively reviewed the charts of 73 patients who were diagnosed with multicystic dysplastic kidney between October 1991 and August 2005. Data were analyzed with respect to patient characteristics and followup information.
Results:
We identified 61 patients (43 boys and 18 girls) with adequate followup. A total of 49 patients (80%) were diagnosed prenatally and 12 (20%) postnatally. Associated urological anomalies were noted in 16 patients (26%). Median followup was 2.6 years (range 6 months to 37.5 years). Ultrasound examinations showed complete involution in 25 patients (41%) and partial regression in 18 (30%). The size of the multicystic dysplastic kidney increased in 1 patient (1.6%) and was unchanged in 17 (28%) without any pathological manifestations. Median age at complete involution was 2.1 years (range 36 days to 13.7 years). Patients with contralateral compensatory hypertrophy had more rapid complete involution. Urinary tract infection developed in 6 patients, of whom 1 was ultimately found to have reflux and 1 had ureteropelvic junction obstruction.
Conclusions:
In our patients with unilateral multicystic dysplastic kidney ultrasound provided little clinically important information. Our data and a review of the literature suggest that once the diagnosis is made, no urological followup is needed. The primary care provider should monitor patients with multicystic dysplastic kidney for hypertension, abdominal mass and urinary tract infection.
References
- 1 : Multicystic dysplastic kidney: is nephrectomy still appropriate?. J Urol1988; 140: 1231. Link, Google Scholar
- 2 : Urinary tract masses. Semin Pediatr Surg2000; 9: 109. Google Scholar
- 3 : Risk of Wilms’ tumour with multicystic kidney disease: a systematic review. Arch Dis Child2005; 90: 147. Google Scholar
- 4 : Risk of hypertension with multicystic kidney disease: a systematic review. Arch Dis Child2005; 90: 921. Google Scholar
- 5 : Report of the Multicystic Kidney Registry: preliminary findings. J Urol1993; 150: 1870. Link, Google Scholar
- 6 : Is the risk of hypertension an indication for prophylactic nephrectomy in patients with unilateral multicystic dysplastic kidney?. Scand J Urol Nephrol2003; 37: 429. Google Scholar
- 7 : Pediatric urological causes of hypertension. J Urol2005; 173: 697. Link, Google Scholar
- 8 : Renal cystic neoplasms and renal neoplasms associated with cystic renal diseases: pathogenetic and molecular links. Adv Anat Pathol2003; 10: 135. Google Scholar
- 9 : Natural history of multicystic kidney conservatively managed: a prospective study. Pediatr Nephrol2004; 19: 1102. Google Scholar
- 10 : Routine voiding cystourethrography is of no value in neonates with unilateral multicystic dysplastic kidney. J Pediatr2005; 146: 759. Google Scholar
- 11 : What is the fate of the refluxing contralateral kidney in children with multicystic dysplastic kidney?. J Urol2004; 172: 1630. Link, Google Scholar
- 12 : Unilateral multicystic dysplastic kidney: experience in children. BJU Int2004; 93: 388. Google Scholar
- 13 : Multicystic renal dysplasia detected by prenatal ultrasonography. Natural history and results of conservative management. Br J Urol1992; 69: 538. Google Scholar
- 14 : Involution rate of multicystic renal dysplasia. Pediatrics1998; 102: E73. Google Scholar
- 15 : Clinical features of unilateral multicystic renal dysplasia in children. Eur J Pediatr1998; 157: 666. Google Scholar
- 16 : Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome. J Pediatr (Rio J)2005; 81: 400. Google Scholar
- 17 : Predictive factors of ultrasonographic involution of prenatally detected multicystic dysplastic kidney. BJU Int2005; 95: 868. Google Scholar
- 18 : Fetal compensatory renal hypertrophy with a unilateral functioning kidney. Ultrasound Obstet Gynecol2000; 15: 191. Google Scholar
- 19 : Follow-up of unilateral multicystic kidney dysplasia after prenatal diagnosis. J Matern Fetal Neonatal Med2003; 14: 177. Google Scholar
- 20 : Outcome and cost analysis of operative versus nonoperative management of neonatal multicystic dysplastic kidneys. J Urol1998; 160: 1207. Link, Google Scholar
Division of Urology, Albany Medical College, Albany, New York
