Multicystic dysplastic kidney detected by fetal sonography: conservative management and follow-up

Oliveira, E. A.; Diniz, José Silvério Santos; Vilasboas, Aranaí S.; Rabelo, Eli Armando Siqueira; Silva, J. M. P.; Filgueiras, Maria Tereza F.F.

doi:10.1007/s003830000449

Cited by 44 publications

(27 citation statements)

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“…Desde então, com os avanços da ultra-sonografia fetal, essa conduta vem sendo substituída pelo seguimento clínico e ecográfico das crianças acometidas 2 . Alguns estudos têm observado ser o tratamento conservador uma opção segura, uma vez que a prevalência de complicações é pequena, e a maioria das unidades afetadas apresenta involução parcial ou completa à ultra-sonografia 4,5 . Recentemente, um estudo comparativo entre o tratamento cirúrgico e o conservador não observou qualquer diferença significativa na freqüência de complicações aos pacientes 6 .…”

Section: Introductionunclassified

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

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

J Pediatr (Rio J)

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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,...

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Section: Introductionunclassified

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

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

J Pediatr (Rio J)

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“…In the first decade of the study, infants were investigated according to a comprehensive systematic protocol described elsewhere (14)(15)(16). After 2000, we developed a more tailored clinical protocol (17)(18)(19).…”

Section: Study Protocolmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

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“…8 In the absence of complications, they are increasingly managed conservatively, but because of the perceived long term risk of hypertension they are also followed up throughout childhood. [8][9][10][11][12] With the risk of hypertension in these children still poorly defined, the strategy and the duration of follow up do not seem to be based on evidence. 3 4 13 14 In addition, even when the spontaneous involution (in approximately 40% of cases) is documented on ultrasound scan and most units cease imaging studies at that point, there may still be a risk of hypertension.…”

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confidence: 99%

Risk of Hypertension With Multicystic Kidney Disease: A Systematic Review

Narchi

2006

Journal of Urology

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Background: Children with multicystic kidney disease (MCKD) are increasingly managed conservatively, and are followed up throughout childhood because of the risk of hypertension highlighted in some reports. With this risk still poorly defined, the strategy and the duration of follow up do not seem to be based on evidence. Methods: Systematic review of the literature for all published cohort studies (prospective and retrospective) of children diagnosed to have unilateral MCKD and managed conservatively. Exclusion criteria were bilateral MCKD, and nephrectomy (not for hypertension) during the follow up period. For children with MCKD, the probability of developing hypertension during the follow up period was estimated. Results: From 29 reviewed studies, six cases of hypertension developed in 1115 eligible children. The mean probability of a child with unilateral MCKD developing hypertension was therefore 5.4 per 1000 (95% CI estimated at 1.9 to 11.7 per 1000). Conclusion: Although the risk of hypertension in MCKD is low, the results of this study do not allow firm recommendations on the frequency and duration of blood pressure measurement follow up for these children. Large prospective cohort studies with a very long duration of follow up are needed.

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Multicystic dysplastic kidney detected by fetal sonography: conservative management and follow-up

Cited by 44 publications

References 0 publications

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

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

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Risk of Hypertension With Multicystic Kidney Disease: A Systematic Review

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