Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment

Carazo-Palacios, M.E.; Couselo-Jerez, M.; Serrano-Durbá, A.; Pemartín-Comella, B.; Sangüesa-Nebot, C.; Estornell-Moragues, F.; Domínguez-Hinarejos, C.

doi:10.1016/j.acuroe.2016.11.004

Cited by 2 publications

(5 citation statements)

References 17 publications

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“…Ultrasound screening of the kidneys and urinary tract is the main diagnostic tool for evaluation of a patient with a cSFK, given its noninvasive nature and high accuracy for diagnosing a cSFK ( Table 1 ) [18] , [19] , [20] . At the first postnatal ultrasound, an attempt should be made to confirm prenatal findings and establish a definitive diagnosis.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Kidney scintigraphy using radioactively labeled dimercaptosuccinic acid (DMSA) or mercapto acetyl tri glycine (MAG-3) can be used to visualize functioning kidney tissue. These studies are not needed routinely when URA or MCDK is suspected, since these diagnoses can be made accurately using sonographic studies of the kidney in >95% of cases [18] , [19] , [20] . Although a DMSA scan is more time consuming for the patients and parents involved, it may be indicated to visualize kidney scarring after a pyelonephritis.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations

Woud

Westland

Feitz

et al. 2021

European Urology Open Science

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Context A congenital solitary functioning kidney (cSFK) is a common developmental defect that predisposes to hypertension and chronic kidney disease (CKD) as a consequence of hyperfiltration. Every urologist takes care of patients with a cSFK, since some will need lifelong urological care or will come with clinical problems or questions to an adult urologist later in life. Objective We aim to provide clear recommendations for the initial clinical management and follow-up of children with a cSFK. Evidence acquisition PubMed and EMBASE were searched to identify relevant publications, which were combined with guidelines on related topics and expert opinion. Evidence synthesis Initially, cSFK diagnosis should be confirmed and risk factors for kidney injury should be identified using ultrasound. Although more research into early predictors of kidney injury is needed, additional congenital anomalies of the kidney or urinary tract and absence of compensatory kidney hypertrophy have repeatedly been associated with a worse prognosis. The role of voiding cystourethrography and antibiotic prophylaxis remains controversial, and is complicated by the exclusion of children with a cSFK from studies. A yearly follow-up for signs of kidney injury is recommended for children with a cSFK. As masked hypertension is prevalent, annual ambulatory blood pressure measurement should be considered. During puberty, an increasing incidence of kidney injury is seen, indicating that long-term follow-up is necessary. If signs of kidney injury are present, angiotensin converting enzyme inhibitors are the first-line drugs of choice. Conclusions This overview points to the urological and medical clinical aspects and long-term care guidance for children with a cSFK, who are at risk of hypertension and CKD. Monitoring for signs of kidney injury is therefore recommended throughout life. Large, prospective studies with long-term follow-up of clearly defined cohorts are still needed to facilitate more risk-based and individualized clinical management. Patient summary Many children are born with only one functioning kidney, which could lead to kidney injury later in life. Therefore, a kidney ultrasound is made soon after birth, and other investigations may be needed as well. Urologists taking care of patients with a solitary functioning kidney should realize the long-term clinical aspects, which might need medical management.

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Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations

Woud

Westland

Feitz

et al. 2021

European Urology Open Science

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“…Previous studies have discussed that renal scintigraphy studies, or even magnetic resonance imaging (MRI), may not necessarily provide additional information over a RUS in confirmation of MCDK. 9,11,17 Whittam et al identified that almost all patients who had a RUS diagnostic of MCDK demonstrated no renal function on subsequent renal scintigraphy studies. 9 This is particularly relevant when considering the importance of reducing radiation in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Two of these four already had evidence of renal impairment prior to obtaining RS, thus making it difficult to assess any potential utility in obtaining RS to predict future risk of CKD. Previous studies have discussed that renal scintigraphy studies, or even magnetic resonance imaging (MRI), may not necessarily provide additional information over a RUS in confirmation of MCDK 9,11,17 . Whittam et al identified that almost all patients who had a RUS diagnostic of MCDK demonstrated no renal function on subsequent renal scintigraphy studies 9 .…”

Section: Discussionmentioning

confidence: 99%

“…This distinction is important as management greatly varies for MCDK versus severe hydronephrosis or other diagnoses. Previous studies have noted that the positive predictive value of renal scintigraphy to ultrasound in confirmation of MCDK is 100%; however, it was undetermined whether early or intermediate term outcomes differed between patients diagnosed with MCDK with or without scintigraphy studies 9,11 . Given the priority for reducing radiation exposure and optimizing cost effectiveness in pediatric patient care, the utility of renal scintigraphy in diagnosis of MCDK should be further elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney

Hannallah

Baker

Filippo

et al. 2022

J of Clinical Ultrasound

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Purpose To compare the prevalence of vesicoureteral reflux (VUR), febrile urinary tract infection (fUTI), and chronic kidney disease (CKD) among patients with multicystic dysplastic kidney (MCDK) diagnosed by renal scintigraphy (RS) versus follow‐up renal ultrasound (RUS) alone. Methods This was a retrospective review of patients seen at a tertiary care center from 2010 to 2020 with MCDK diagnosed by RS or follow‐up RUS. Differences in the prevalence of VUR, fUTI, and CKD by cohort were assessed using logistic regression analysis, Pearson X2, and Fisher's Exact tests. Temporal trends in diagnostic methods used (RUS versus RUS + RS) were evaluated using the Cochran‐Armitage trend test. Results One‐hundred seventy‐two patients were included: 50% (n = 86) underwent RUS + RS and 50% (n = 86) underwent RUS alone to diagnose MCDK. Prevalence of VUR, fUTI, and CKD did not significantly vary between groups. Among patients who had a VCUG, 4.4% had contralateral VUR (1.7% RUS + RS group; 7.4% RUS group; p = 0.19) and 14.5% had at least one fUTI (16.3% RUS + RS group; 12.8% RUS group; p = 0.52). Females were significantly more likely to have at least one fUTI (p = 0.04). Four patients (2.3%) developed CKD, all in the RUS + RS cohort (p = 0.12). Diagnosis of MCDK by RUS versus RUS + RS did not significantly vary over time (p = 0.17). Conclusion Patients with unilateral MCDK confirmed by RS versus RUS alone do not significantly vary in the prevalence of VUR, fUTI, or CKD. Renal scintigraphy studies may not be necessary in unilateral MCDK diagnosis but continue to be used.

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Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment

Cited by 2 publications

References 17 publications

Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations

Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations

Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney

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