Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary?

Blachman‐Braun, Ruben; Becerra, Maria F.; Guevara, Christian G.; Velasquez, Maria C.; Moscardi, Paulo Renato Marcelo; Ballesteros, Natalia; Gosálbez, Rafael; Labbie, Andrew; Castellán, Miguel; Restrepo, Ricardo; Alam, Alireza

doi:10.1016/j.urology.2020.02.005

Cited by 11 publications

(15 citation statements)

References 24 publications

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“…Blachman-Braun et al evaluated 156 MCDK patients; 38 of them had abnormal US findings in the contralateral kidney, and when a VCUG was performed, they found 25 patients with VUR; however; only two of them had severe VUR. They showed a statistical correlation between the severity of VUR and abnormal US findings [34]. Therefore, they concluded that patients with abnormal contralateral US findings would benefit the most from VCUG.…”

Section: Discussionmentioning

confidence: 95%

Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey

Kara¹,

Taktak²,

Alparslan³

2021

Turk J Med Sci

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Section: Discussionmentioning

confidence: 95%

Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey

Kara¹,

Taktak²,

Alparslan³

2021

Turk J Med Sci

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“…Among the urologic abnormalities associated with CSK, vesicoureteral reflux is the most common [ 1 , 2 , 7 , 31 , 41 ]. Two systematic reviews involving over 5600 patients with MCDK or UKA, 2874 having been examined for the presence of VUR, showed an overall rate of about one in five patients [ 1 , 2 ].…”

Section: What Further Imaging Is Required When a Csk Is Confirmed?mentioning

confidence: 99%

“…Two systematic reviews involving over 5600 patients with MCDK or UKA, 2874 having been examined for the presence of VUR, showed an overall rate of about one in five patients [ 1 , 2 ]. However, severe VUR (i.e., grades III–V according to the International Reflux Study classification) appears to be infrequent, having been documented in 9% of children with CSK overall in recent series [ 1 , 7 , 31 , 41 – 43 ] (Table 1 ).…”

Section: What Further Imaging Is Required When a Csk Is Confirmed?mentioning

confidence: 99%

“…However, from a clinical point of view, low grade VUR is increasingly recognized as negligible, in terms of both the rate of UTI and the risk of kidney scarring, while the role severe VUR plays in clinical outcome is still debated, as conclusive evidence is lacking [ 45 ]. Multiple studies have demonstrated a low incidence of clinically significant VUR in children with MCDK and a normal contralateral kidney and bladder on US [ 41 ]; furthermore, Brown et al found that knowledge of VUR in 77 children with MCDK screened by VCUG did not change patient management [ 43 ]. Accordingly, we believe that routine screening for VUR is not necessary in the presence of a normal CSK on US (Box 1).…”

Section: What Further Imaging Is Required When a Csk Is Confirmed?mentioning

confidence: 99%

“…In this context, in our opinion, an isolated dilatation of the renal pelvis ≤ 10 mm does not represent an indication for VCUG. On the other hand, it has been shown that in children with an abnormal CSK on US, the probability of a high grade VUR is elevated [ 41 , 46 ]. In the risk analysis performed by Blachman-Braun et al, a significant association (odds ratio = 7.73; 95%CI: 1.43–41.81; p = 0.018) between abnormal CSK on US (defined as abnormal contralateral kidney, presence of hydronephrosis, duplex configuration, ureterocele, hydroureter, or uroepithelial thickening) and severe VUR was demonstrated in 156 MCDK patients [ 41 ].…”

Section: What Further Imaging Is Required When a Csk Is Confirmed?mentioning

confidence: 99%

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Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology

Scola

Ammenti²,

Bertulli

et al. 2022

Pediatr Nephrol

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Background In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), with controversial results, and a worldwide consensus on management and follow-up is lacking. In this consensus statement, the Italian Society of Pediatric Nephrology summarizes the current knowledge on CSK and presents recommendations for its management, including diagnostic approach, nutritional and lifestyle habits, and follow-up. Summary of the recommendations We recommend that any antenatal suspicion/diagnosis of CSK be confirmed by neonatal ultrasound (US), avoiding the routine use of further imaging if no other anomalies of kidney/urinary tract are detected. A CSK without additional abnormalities is expected to undergo compensatory enlargement, which should be assessed by US. We recommend that urinalysis, but not blood tests or genetic analysis, be routinely performed at diagnosis in infants and children showing compensatory enlargement of the CSK. Extrarenal malformations should be searched for, particularly genital tract malformations in females. An excessive protein and salt intake should be avoided, while sport participation should not be restricted. We recommend a lifelong follow-up, which should be tailored on risk stratification, as follows: low risk: CSK with compensatory enlargement, medium risk: CSK without compensatory enlargement and/or additional CAKUT, and high risk: decreased GFR and/or proteinuria, and/or hypertension. We recommend that in children at low-risk periodic US, urinalysis and BP measurement be performed; in those at medium risk, we recommend that serum creatinine also be measured; in high-risk children, the schedule has to be tailored according to kidney function and clinical data.

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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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Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary?

Cited by 11 publications

References 24 publications

Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey

Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey

Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology

Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney

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