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PEDIATRIC
UROLOGY
Natural
History of Patients With Multicystic Dysplastic Kidney-What Followup Is
Needed?
Onal B, Kogan BA
Division of Urology, Albany Medical College, Albany, New York, USA
J Urol. 2006; 176: 1607-11
- 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.
- Editorial
Comment
This is an interesting review of 73 patients between 1991 and 2005 diagnosed
with multicystic kidney disease. Of these 61 patients, 43 boys and 18
girls, had follow up with ultrasound postnatally and VCUG or renal scan.
Median age at diagnosis was 1.5 years and median follow up was 2.6 years
with the median number of ultrasounds per patient was 4. Associated
urologic anomalies were found in 16 patients. Most were vesicoureteral
reflux. Four had ureteroceles and 1 had a contralateral ureteropelvic
junction obstruction. The authors evaluated their patients thoroughly
for hypertension and development of kidney tumors and none of their
patients developed either. Only one of their patients had an increase
in size in the multicystic kidney. They conclude that multicystic dysplastic
kidney patients should have a postnatal ultrasound and VCUG and only
patients with associated urologic anomalies should have continual follow
up.
This data seems to mirror that which is seen in the medical literature
and there is very little evidence that multicystic dysplastic kidney
patients will develop hypertension at any increased rate or develop
a kidney tumor. Many have recommended that the ultrasounds be done at
least until age 8 or even puberty. In this study, the actual follow
up is relatively short but their lack of findings seems to validate
their conclusions that routine imaging is unnecessary.
Dr.
Brent W. Snow
University of Utah Health Sci Ctr
Division of Urology
Salt Lake City, Utah, USA |