Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

Abstract

Objective: The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney.Methods: Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth. Results:The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. Conclusion:The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life. ResumoObjetivo: Descrever o curso clínico e a evolução ultra-sonográfica de pacientes com rim displásico multicístico tratados conservadoramente.Métodos: Foram incluídoa no estudo 53 crianças com rim displá-sico multicístico unilateral diagnosticado pela ultra-sonografia fetal entre 1989 e 2004. Todos os pacientes foram submetidos a protocolo sistemático, incluindo tratamento conservador e exames clínicos, laboratoriais e ultra-sonográficos periódicos. Os exames foram realizados com periodicidade de 6 meses, nos 2 primeiros anos, e anualmente, após esse período. No curso clínico, foram avaliados: pressão arterial, infecção do trato urinário, função renal e crescimento dos pacientes. Na evolução ecográfica, foram avaliados a involução do rim displásico multicístico e o crescimento do rim contralateral.Resultados: O tempo médio de seguimento foi de 68 meses. Dois pacientes apresentaram hipertensão arterial no seguimento. Cinco tiveram infecção urinária (apenas um com episódios repetidos). Não houve degeneração maligna do rim displásico multicístico. Foram realizados 334 exames ultra-sonográficos seriados. Houve involução do rim displásico multicístico em 90% dos casos,...

Cyst-to-kidney volume ratio in the sonographic diagnosis of unilateral multicystic dysplastic kidney in children

“…In our study, follow-up sonograms showed complete involution or regression in the majority of the MCDKs (70.6%) while demonstrating no size increase in the rest of them (29.4%), which helped the clinicians avoid unnecessary nephrectomies. The consequences of long-term followups in pediatric patients with MCDKs demonstrate that conservative management under US control is reliable also for the contralateral kidney [36]. As an example, Kuwertz-Broeking et al [10] reported the dilatation of the urinary tract on the contralateral side to be present in 12% of the 97 children with MCDKs children included in the study, which was similar to our results.…”

“…US was declared to be the most suitable tool for the initial evaluation of children with MCDK [33], while the primary approach to the patients with MCDK was reported to be conservative follow-ups by utilizing US [20,34,35]. Though an overt tendency for MCDK to show a timedependent regression in size has been reported [36], the results of the long-term study conducted by Aslam et al [35] revealed that in 41% of the children with unilateral MCDK, renal remnants still persist 10 years after the initial diagnosis, which justifies the need for sonographic follow-ups. Nephrectomy was the usual treatment for unilateral MCDKs in the past; however, due to the high incidence of spontaneous regression and involution, a conservative and clinical management is preferred today [4,25,26], which includes yearly clinical evaluations and US examinations with increased intervals [20].…”

Sonographic long-term study: paediatric growth charts for single kidneys

“…This is less frequent than the reported range of 45–77% 24 25 26. Using the more common and less stringent definition of only a single measurement exceeding the 95% CI, 61% of our “single kidneys” qualify for compensatory renal hypertrophy.…”

Multicystic dysplastic kidney: four-year evaluation

“…Some studies have shown that conservative management seems to be a safe option; the prevalence of complications is negligible and most of the affected units have partial or complete involution on US. Recently, a comparative study between surgical and conservative treatments has not revealed any significant difference in the frequency of complications for the patients (30).…”