Spontaneous improvement of hypertension in multicystic dysplastic kidney: a case report

Oliveira, Eduardo A.; Silva, Ana Cristina Simões; Rabelo, Eli Armando Siqueira; Filgueiras, Maria Tereza F.F.; Pereira, Alamanda Kfoury; Mesquita, Francesca M.

doi:10.1007/s00467-002-0905-3

“…6 After extensive literature review, we found only 19 cases of systemic hypertension associated with MDK. 13 In our patient population, as with several studies, there was no report of malignant transformation of MDK. This is a possible complication that has been sporadically described.…”

Section: Discussionsupporting

confidence: 68%

“…The incidence of complications was negligible, only one patient had high blood pressure caused by MDK, with spontaneous resolution. 13 Serial ultrasound exams revealed involution of MDK in 48 (90%) cases, of which nine (17%) units became undetectable during the follow-up. After the sixth year of life, all the affected renal units were below the 5th percentile of the renal length expected for age.…”

Section: Discussionmentioning

confidence: 94%

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

J. Pediatr. (Rio J.)

Self Cite

0

View full text Add to dashboard Cite

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.J Pediatr (Rio J). 2005;81(5):400-4: Multicystic kidney, management, hypertension, ultrasonography.

show abstract

“…Não houve necessidade de remoção cirúrgica do RDM durante o período de seguimento. A incidência de complicações foi pequena; apenas uma paciente apresentou elevação da pressão arterial atribuída ao RDM, com melhora espontânea 13 . Os exames ultra-sonográficos seriados mostraram involução do RDM em 48 (90%) casos, sendo que nove (17%) unidades se tornaram indetectáveis no transcorrer do seguimento.…”

Section: Discussionunclassified

“…Apenas no estudo multicêntrico realizado na Alemanha foram relatados cinco casos (2,5%) de hipertensão arterial em 204 crianças acompanhadas 6 . Após extensa revisão da literatura, encontramos apenas 19 casos de hipertensão arterial sistêmica associada com RDM 13 . Em nossa casuística, assim como nas várias séries publicadas, não houve relato de transformação maligna do RDM.…”

Section: Discussionunclassified

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

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

Self Cite

View full text Add to dashboard Cite

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,...

show abstract

“…Some smaller studies of patients born with solitary functioning kidneys conclude that these individuals are at risk of hypertension later in life, from hyperfiltration and/or elevated renin activity [38][39][40][41]. Furthermore, case reports have described how MCDK patients with hypertension were cured by nephrectomy of the affected kidney [42][43][44].…”

Section: Blood Pressurementioning

confidence: 94%

Management and etiology of the unilateral multicystic dysplastic kidney: a review

Hains

¹

,

Bates

²

,

Ingraham

³

et al. 2009

View full text Add to dashboard Cite

In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5-43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19-73%, compensatory hypertrophy of the contralateral kidney occurs from 24-81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86-122 ml/min per 1.73 m(2) body surface area. Most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm. The risk of hypertension in those with MCDKs does not appear to be greater than that of the general population, and the rates of malignant transformation of MCDK are small, if at all increased, in comparison with those in the general population. If the patient develops a urinary tract infection or has abnormalities of the contralateral kidney, shown on ultrasound, a voiding cystourethrogram is recommended. Finally, the body of literature does not support the routine surgical removal of MCDKs.

show abstract

Spontaneous improvement of hypertension in multicystic dysplastic kidney: a case report

Cited by 20 publications

References 21 publications

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

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

Management and etiology of the unilateral multicystic dysplastic kidney: a review

Contact Info

Product

Resources

About