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Kopač M, Kordič R. Associated Anomalies and Complications of Multicystic Dysplastic Kidney. Pediatr Rep 2022; 14:375-379. [PMID: 36136083 PMCID: PMC9504218 DOI: 10.3390/pediatric14030044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To assess multicystic dysplastic kidneys (MCDK) in children, their complications and associated congenital genitourinary anomalies. METHODS Children with unilateral MCDK, evaluated between 2012 and 2020, were analyzed. In this retrospective study, data were obtained from electronic and paper health care records. RESULTS There were 80 children included. Follow-up time was 8.0 +/- 5.2 years (mean +/- standard deviation). None of them had hypertension. In total, 43.8% of the children had associated congenital genitourinary anomalies, most commonly cryptorchidism and vesicoureteral reflux (VUR), and 6.3% of these children had chromosomopathy. All of them had normal kidney function except one child with dysplasia of the contralateral kidney. Urinalysis was normal in 90% of children. Extrarenal malformations occurred in 22.5% of them. We observed spontaneous involution of MCDK in 38.8% of children in the observed period. Nephrectomy was performed in 12.5% of children, at an average age of 2.0 years. CONCLUSIONS Children with a unilateral MCDK have a very good prognosis if the contralateral kidney is normal. Associated congenital genitourinary anomalies are common. Cryptorchidism was found to be the most common associated anomaly among boys, which is unique for this study. Most of these children do not suffer from hypertension, kidney dysfunction or other complications.
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Affiliation(s)
- Matjaž Kopač
- Division of Pediatrics, Department of Nephrology, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-522-9626; Fax: +386-1-522-9620
| | - Robert Kordič
- Division of Surgery, Department of Pediatric Surgery, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
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Cheng Y, Cheng Y. Ovarian cysts. Am J Obstet Gynecol 2021; 225:B23-B25. [PMID: 34507793 DOI: 10.1016/j.ajog.2021.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Magnetic resonance imaging for evaluation of foetal multicystic dysplastic kidney. Eur J Radiol 2018; 108:128-132. [PMID: 30396644 DOI: 10.1016/j.ejrad.2018.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/18/2022]
Abstract
We sought to evaluate the diagnostic value of foetal magnetic resonance imaging (MRI) for multicystic dysplastic kidney (MCDK) disease. We retrospectively identified 55 foetuses with MCDK diagnosed (51 unilateral; 4 bilateral) by foetal MRI. We analysed the anatomical findings by prenatal MRI and compared them with the prenatal ultrasound (US) and postnatal findings. Additional diagnostic information added by MRI was recorded. The gestational age of the 55 foetuses ranged from 22 to 35 weeks (mean, 26.5 ± 3.6 weeks). The age of the pregnant women ranged from 23 to 40 years (mean, 31 ± 4.2 years). All 55 cases were performed at 1.5 T magnetic resonance unit. MRI sequences, including steady-state free precession (SSFP), single-shot fast spin echo (SSFSE), T1-weighted imaging (T1WI), and diffusion weighted imaging (DWI) sequences. Follow-up was obtained for 53 cases (2 cases of autopsy, 51 cases of postnatal imaging or surgery confirmed). Among the 51 unilateral cases, 16 cases were associated with other urinary tract anomalies, 3 cases with extra-renal anomalies, and the remaining 32 cases without associated anomalies. 2 of 16 cases with contralateral renal agenesis were with oligohydramnios and pulmonary hypoplasia. 2 of 4 bilateral MCDK presented with oligohydramnios and pulmonary hypoplasia. 52 of 53 cases were correctly diagnosed by MRI compared with the final diagnoses; 40 of 53 (75.5%) cases were correctly diagnosed by prenatal ultrasound. Both prenatal ultrasound and MRI failed to correctly diagnose one case bilateral MCDK, and MRI correctly changed the ultrasound diagnosis in 12 cases. Foetal MRI can add additional diagnostic information to prenatal US in the assessment of MCDK, even change the prenatal counselling and decisions.
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Predictors of poor neonatal outcomes in prenatally diagnosed multicystic dysplastic kidney disease. J Perinatol 2018; 38:658-664. [PMID: 29572458 DOI: 10.1038/s41372-018-0093-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Multicystic dysplastic kidney (MCDK) is one of the most common anomalies detected by prenatal ultrasound. Our objective was to identify factors associated with severe adverse neonatal outcomes of prenatally diagnosed MCDK STUDY DESIGN: A retrospective review of prenatally diagnosed MCDK (1 January 2009 to 30 December 2014) from a single academic center was conducted. The primary outcome was death or need for dialysis among live-born infants. Associations between prenatal characteristics and outcome were analyzed by Fisher's exact test and Mann-Whitney test. RESULTS A total of 53 cases of prenatally suspected MCDK were included, of which 46 cases were live-born and confirmed postnatally (38 survivors, 8 non-survivors). Prenatally diagnosed extrarenal anomalies, bilateral MCDK, contralateral renal anomalies, and anhydramnios were significantly associated with death or need for dialysis (all p < 0.0001). CONCLUSIONS Prenatally identified findings are associated with adverse neonatal outcome, and can guide counseling and management planning. In the absence of significant associated findings, prenatally diagnosed unilateral MCDK has a benign neonatal course.
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Scala C, McDonnell S, Murphy F, Leone Roberti Maggiore U, Khalil A, Bhide A, Thilaganathan B, Papageorghiou AT. Diagnostic accuracy of midtrimester antenatal ultrasound for multicystic dysplastic kidneys. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:464-469. [PMID: 27643400 DOI: 10.1002/uog.17305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To establish the diagnostic accuracy of obstetric ultrasound at a tertiary fetal medicine center in the prenatal detection of unilateral and bilateral multicystic dysplastic kidney (MCDK) in fetuses in which this condition was suspected, and to undertake a systematic review of the relevant literature. METHODS This was a retrospective observational study of all cases referred to a regional tertiary fetal medicine unit due to suspicion of either unilateral or bilateral MCDK between 1997 and 2015. Diagnosis was confirmed by postnatal ultrasound reports or postmortem examination. The accuracy of prenatal ultrasound in the diagnosis of MCDK was calculated. Using a systematic search strategy we also performed a review of the literature regarding the prenatal diagnosis and diagnostic accuracy of MCDK. RESULTS We included 144 women in our analysis; 37 (25.7%) opted for pregnancy termination (TOP) (due to unilateral MCDK with additional abnormalities, suspected bilateral MCDK or severe obstructive uropathy). Complete pre- and postnatal data were available in 126 pregnancies, including 104 livebirths, 19 TOPs with postmortem findings available and three intrauterine fetal deaths. Two infants died shortly after birth (due to known bilateral MCDK or known cranial vault defect). The overall number of cases of MCDK confirmed postnatally was 100; of these, 98 were diagnosed prenatally (true positive), while two were thought to be hydronephrosis prenatally (false negative) and the diagnosis of MCDK was made after birth. In nine cases, the initial antenatal diagnosis of suspected MCDK was revised, either later in pregnancy (n = 2) or postnatally (n = 7) (false positive). Overall, the diagnostic accuracy in our population for the use of antenatal ultrasound to detect MCDK was 91.3%, while that reported in the existing literature was found to range from 53.3% to 100%. MCDK was isolated in the majority (71%) of cases, while in 29% of cases it was found to be associated with other renal and extrarenal fetal abnormalities. CONCLUSIONS Antenatal ultrasound had a diagnostic accuracy of about 91% in the prediction of postnatal MCDK and can therefore be used to guide antenatal counseling. However, prenatal or postnatal revision of the diagnosis occurred in about 7% of cases and parents should be counseled appropriately. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Scala
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - S McDonnell
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - F Murphy
- Department of Paediatric Surgery, St George's Healthcare NHS Trust, London, UK
| | - U Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino, IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Bhide
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - B Thilaganathan
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A T Papageorghiou
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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Tran PL, Guichard J, Lazaro G, Boukerrou M. Prenatal diagnosis of bilateral multicystic dysplastic kidney in three siblings. ACTA ACUST UNITED AC 2016; 44:187-90. [PMID: 26966031 DOI: 10.1016/j.gyobfe.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Affiliation(s)
- P L Tran
- Department of Gynecology and Obstetrics, University Hospital of South Reunion Island, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - J Guichard
- Department of Gynecology and Obstetrics, University Hospital of South Reunion Island, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - G Lazaro
- European Cancer Stem Cell Institute, Haydn Ellis Building, Cardiff University, Maindy Road, CF24 4HQ Cardiff, United Kingdom
| | - M Boukerrou
- Department of Gynecology and Obstetrics, University Hospital of South Reunion Island, BP 350, 97448 Saint-Pierre cedex, Reunion; CEPOI, Perinatal Center of Study of the Indian Ocean, University Hospital of South Reunion Island, Faculty of medicine, Saint-Pierre 97448, Reunion; Faculty of Medicine, University of Reunion, 97490 Saint-Denis, Reunion.
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Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Winding L, Loane M, Wellesley D, Addor MC, Arriola L, Bakker MK, Bianchi F, Calzolari E, Gatt M, Haeusler M, Lelong N, Mullaney C, Scarano G, Tucker D, Wiesel A, Garne E. Prenatal diagnosis and epidemiology of multicystic kidney dysplasia in Europe. Prenat Diagn 2014; 34:1093-8. [DOI: 10.1002/pd.4433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Louise Winding
- Paediatric Department; Hospital Lillebaelt; Kolding Denmark
| | | | | | - Marie-Claude Addor
- Registry of Vaud Switzerland, Division of Medical Genetics; CHUV; Lausanne Switzerland
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government; CIBER Epidemiología y Salud Pública - CIBERESP; Madrid Spain
| | - Marian K. Bakker
- EUROCAT Northern Netherlands, Department of Genetics; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Fabrizio Bianchi
- CNR Institute of Clinical Physiology and G. Monasterio Tuscany Foundation; Pisa Italy
| | - Elisa Calzolari
- Registro IMER - IMER Registry (Emila Romagna Registry of Birth Defects); Azienda Ospedaliero-Universitaria di Ferrara; Ferrara Italy
| | - Miriam Gatt
- Malta Congenital Anomalies Register; Directorate for Health Information and Research; Valletta Malta
| | | | | | - Carmel Mullaney
- South East Ireland Congenital Anomaly (EUROCAT) Registry, Public Health Department; HSE South (South East); Kilkenny Ireland
| | | | | | - Awi Wiesel
- Department of Paediatrics; University Medical Centre of the Johannes Gutenberg University Mainz; Mainz Germany
| | - Ester Garne
- Paediatric Department; Hospital Lillebaelt; Kolding Denmark
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Associated nonurinary congenital anomalies among infants with congenital anomalies of kidney and urinary tract (CAKUT). Eur J Med Genet 2014; 57:322-8. [DOI: 10.1016/j.ejmg.2014.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/13/2014] [Indexed: 02/07/2023]
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Cooper CJ, Said S, Khalillullah S, Salameh HJ, Hernandez GT. Multicystic dysplastic kidney complicated by pyelonephritis. Am J Case Rep 2013; 14:412-5. [PMID: 24349603 PMCID: PMC3864172 DOI: 10.12659/ajcr.889557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 07/29/2013] [Indexed: 01/06/2023] Open
Abstract
Patient: Female, 21 Final Diagnosis: Multicystic Dysplastic Kidney Disease complicated by pyelonephritis Symptoms: Left flank pain (CVAT) • dysuria • fever Medication: Levofloxacin Clinical Procedure: Dimercaptosuccinic acid scan • voiding cystouretrogram Specialty: Nephrology
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Affiliation(s)
- Chad J Cooper
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Sarmad Said
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Sayeed Khalillullah
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Hasan J Salameh
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - German T Hernandez
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
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Al Naimi A, Baumüller JE, Spahn S, Bahlmann F. Prenatal diagnosis of multicystic dysplastic kidney disease in the second trimester screening. Prenat Diagn 2013; 33:726-31. [DOI: 10.1002/pd.4112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 02/15/2013] [Accepted: 03/21/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Ammar Al Naimi
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt; Frankfurt am Main Germany
| | - Jan-Eric Baumüller
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt; Frankfurt am Main Germany
| | - Stephan Spahn
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt; Frankfurt am Main Germany
| | - Franz Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt; Frankfurt am Main Germany
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Psooy K. Multicystic dysplastic kidney in the neonate: the role of the urologist. Can Urol Assoc J 2011; 4:95-7. [PMID: 20368889 DOI: 10.5489/cuaj.10022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Karen Psooy
- Division of Pediatric Urology, Winnipeg Children's Hospital, Winnipeg, MB
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Abstract
Introduction Congenital fetal anomalies are the great problem and one of the main causes of increased perinatal mortality and morbidity. The aim of this study is to determine the outcome of prenataly detected multicystic dysplastic kidney and to point to the necessity of postnatal diagnostic procedures. Material and methods The retrospective-prospective study encompasses 38 cases of the prenatally diagnosed unilateral fetal multicystic dysplastic kidney. The associated anomalies were revealed either by autopsy findings when the pregnancy was terminated, or when the pregnancy continued, by clinical and operative findings the newborns. Results The autopsy finding revealed bilateral multicystic displastic kidney or unilateral mylticystic displastic kidney and the agenesis of the contralateral kidney. The postnatal evaluation of the newborns with unilateral multicistic disease revealed that 84.3% of them had some concomitant anomaly of the urinary tract, most of them had an anomaly of the contralateral kidney (31.4%). The surgery was performed in 73.6% of children, in 17% of children the kidney function deteriorated after the surgery. Conclusion The findings of bilateral multicystic kidney disease and unilateral multicystic kidney disease and anamnion are the indication to terminate the pregnancy. The finding of an isolated unilateral multicystic dysplastic kidney require thorough examination, both prenatally and postnatally. We propose obligatory serial prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and urinary cystourethography.
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[Association of fetal unilateral multicystic kidney disease with other urinary tract anomalies]. VOJNOSANIT PREGL 2009; 66:733-7. [PMID: 19877553 DOI: 10.2298/vsp0909733p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Multicystic dysplastic kidney represents a disorder in the fetus development presented prenatally of postnatally, this deserving special attention due to a risk of additional anomalies in children with this disorder. The aim of this study was to determine the incidence and type of common anomalies of the urinary system in the prenatal diagnosis of unilateral multicystic dysplastic kidney, and point out the necessity of postnatal diagnostic procedures in order to evaluate the state of the urinary system. METHODS This retrospective-prospective study encompassed 38 cases of prenatally diagnosed unilateral fetal multicystic dysplastic kidney, presented to the Council for Fetal Anomalies from the Institute for Gynecology and Obstetrics of the Clinical Centre of Serbia and the University Children's Clinic within a three-year period. Associated anomalies were revealed by autopsy findings when pregnancy was terminated, ie resumed with clinical and operative findings of born children. RESULTS In every case of terminated pregnancy and death after birth the autopsy revealed additional renal or exstrarenal anomaly which were not prenataly detected. Postnatal evaluation of survived children with unilateral multicistic disease revealed that 31.4% of them have an anomaly of the contralateral kidney, 26.3% anomaly of the ipsilateral side, 13.2% anomaly of the lower portions of the urinary system and the same percent an additional extrarenal anomaly. The surgery was performed in 73.6% of children, more than half of the interventions were related to extrarenal anomaly. In 17% of children the kidney function was deteriorated after surgery. CONCLUSION Children suffering from unilateral multicystic dysplastic kidney have a greater chance of exhibiting an anomaly of the contralateral kidney and the urinary system in general. Therefore, they require thorough examination, both prenatally and postnatally. We propose obligatory serial professional prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and we especially emphasize the need for performing urinary cystouretherography, bearing in mind the high incidence of the vesicoureteral reflux of the contralateral kidney. In addition to nephrectomy, cytoscopy and colposcopy also need to be performed for the purpose of discovering possible hidden anomalies of the urogenital system.
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Hains DS, Bates CM, Ingraham S, Schwaderer AL. Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 2009; 24:233-41. [PMID: 18481111 DOI: 10.1007/s00467-008-0828-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- David S Hains
- Department of Pediatrics, Division of Pediatric Nephrology, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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Schreuder MF, Westland R, van Wijk JAE. Unilateral multicystic dysplastic kidney: a meta-analysis of observational studies on the incidence, associated urinary tract malformations and the contralateral kidney. Nephrol Dial Transplant 2009; 24:1810-8. [PMID: 19171687 DOI: 10.1093/ndt/gfn777] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many papers are published on cohorts with unilateral multicystic dysplastic kidney (MCDK) patients, but show variable results as to the incidence of associated urinary tract abnormalities. The objective of this study was to describe the status of the urinary tract, including contralateral hypertrophy and malformations, in patients with unilateral MCDK based on a meta-analysis of the literature, taking into account the timing of diagnosis (pre- versus postnatal) as a possible source of bias. METHODS A systematic review of the scientific literature in English was conducted using PubMed and Embase. A meta-analysis was performed with the studies that were identified using our reproducible search. RESULTS Based on analysis of the data in 19 populations, the overall incidence of unilateral MCDK is 1 in 4300 with an increasing trend over the years. A total of 67 cohorts with over 3500 patients with unilateral MCDK were included in the meta-analysis. Fifty-nine percent of patients were male and the MCDKs were significantly more often found on the left side (53.1%). Associated anomalies in the solitary functioning kidney were found in 1 in 3 patients, mainly vesicoureteric reflux (VUR, in 19.7%). In patients with VUR, 40% have severe contralateral VUR, defined as grade III-V. Contralateral hypertrophy, present in 77% of patients after a follow-up of at least 10 years, showed a trend to be less pronounced in patients with VUR. Timing of the diagnosis of MCDK did not essentially influence the results. CONCLUSIONS These aggregate results provide insight into the incidence, demographic data and associated anomalies in patients with unilateral MCDK. One in three patients with unilateral MCDK show anomalies in the contralateral, solitary functioning kidney. However, studies into the long-term consequences of these anomalies are scarce.
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Affiliation(s)
- Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud University Nijmegen Medical Centre, Amsterdam, The Netherlands.
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Unilateral multicystic dysplastic kidney: single-center experience. Pediatr Nephrol 2009; 24:99-104. [PMID: 18696120 DOI: 10.1007/s00467-008-0942-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 06/02/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
Abstract
Multicystic dysplastic kidney (MCDK) is one of the most common renal abnormalities in children. The aim of our study was to evaluate the clinical course and outcome of patients with MCDK. Ninety pediatric patients with unilateral MCDK followed by the Pediatric Nephrology Department of Bakirkoy Maternity and Children's Hospital between 1990 and 2007 were included in this retrospective study. The dimercaptosuccinic acid radionuclide scan revealed no function in MCDK in all of our patients. Voiding cystourethrogram was performed in all patients. Twenty patients (22.2%) had abnormalities in the contralateral kidney. Nephrectomy was performed in 41 patients (45.5%). Twelve patients had undergone routine nephrectomy before 1996. Since then, patients have been followed up conservatively, and nephrectomy has been performed only when indicated. Indication of nephrectomy was arterial hypertension in 16 patients (23.1%), recurrent urinary tract infection (UTI) in 11 (15.9%), and severe abdominal pain in two (2.8%). Hypertension was noted within the first year of life in all patients except two. MCDK completely involuted in 39.3% within 48 months. There was no malignant transformation, proteinuria, or renal failure. In conclusion, hypertension is often noticed in infants with MCDK. Uninephrectomy leads to normalization. However, prospective studies are needed to exclude a spontaneous improvement of hypertension.
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Bacchetta J, Liutkus A, Dodat H, Cochat P. [Multicystic dysplastic kidney disease: update and information for parents at the time of prenatal diagnosis]. Arch Pediatr 2008; 15:1107-15. [PMID: 18462928 DOI: 10.1016/j.arcped.2008.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 12/03/2007] [Accepted: 02/23/2008] [Indexed: 11/17/2022]
Abstract
Multicystic kidney disease (MCKD) is the most common form of Congenital Abnormality of Kidney and Urinary Tract (CAKUT). This anomaly of renal development is characterized by unilateral enlarged cystic formations and fibrous dysplastic parenchyma. The long-term prognosis is usually good; however because of reduced nephron mass, an early prevention of cardiovascular risk and nephrotoxicity is recommended. A lifelong follow-up of blood pressure, serum creatinine and microalbuminuria seems logical as well as in other patients with a single kidney. MCKD is usually diagnosed during pregnancy so that parents often question about long-term prognosis and follow-up. Therefore, we propose an information sheet for parents.
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Affiliation(s)
- J Bacchetta
- Département de pédiatrie, hôpital Edouard-Herriot, université Lyon-1,5, place d'Arsonval 69437 Lyon, France
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Renal dysplasia and MRI: a clinician's perspective. Pediatr Radiol 2008; 38 Suppl 1:S70-5. [PMID: 18071696 DOI: 10.1007/s00247-007-0586-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 07/10/2007] [Indexed: 01/13/2023]
Abstract
Renal dysplasia is a common abnormality in children. The role of MRI in evaluating children with renal dysplasia is evolving. More information is clearly necessary before MRI replaces conventional imaging modalities. In order to appropriately use MRI, the radiologist must have an understanding of the clinical questions that are important in the management of children with renal dysplasia. This review provides background information on renal dysplasia for the pediatric radiologist. The focus is on unilateral disease, especially multicystic dysplastic kidneys, and bilateral dysplasia, which is the most common cause of kidney failure in children. The emphasis is on the important clinical issues, and the potential of MRI as a methodology for providing clinically useful information not otherwise available from other imaging modalities.
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Affiliation(s)
- A S Woolf
- Nephro-Urology Unit, Institute of Child Health, University College London, London, UK.
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Guarino N, Casamassima MGS, Tadini B, Marras E, Lace R, Bianchi M. Natural history of vesicoureteral reflux associated with kidney anomalies. Urology 2005; 65:1208-11. [PMID: 15913724 DOI: 10.1016/j.urology.2005.01.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Revised: 01/05/2005] [Accepted: 01/24/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the cystographic follow-up of patients with multicystic dysplastic kidney (MCDK), renal agenesis, and renal ectopia with associated primary vesicoureteral reflux (VUR). METHODS Patients with primary associated VUR (grade 2 or more) and with a minimal follow-up of 24 months were included in this study. RESULTS Of the children with renal agenesis, 24% had VUR. The median grade of VUR was significantly greater in the boys than in the girls (4 versus 2, respectively; P < 0.05). All girls and 34% of the boys experienced spontaneous resolution 1 year after diagnosis; 66% of the boys required operative treatment. Of the patients with MCDK, 16% had VUR. The median grade of VUR in the kidney contralateral to the MCDK was greater in the boys than in the girls (3.5 versus 2, respectively; P = 0.06). All girls and 60% of the boys had spontaneous resolution 1 year after diagnosis; 40% of the boys underwent operative treatment. Of the children with renal ectopia, 30% had VUR. The median grade of VUR for the refluxing unit was significantly greater in the girls than in the boys (3 versus 2, respectively; P < 0.05). Spontaneous resolution of VUR was observed in all boys (66% at 1 year) and in 40% of the girls; 60% of the girls required operative treatment. CONCLUSIONS Spontaneous resolution of VUR can be anticipated in girls with MCDK or renal agenesis and in boys with renal ectopia. These data can be used in planning the proper follow-up schedule for babies with a kidney anomaly detected by ultrasonography.
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Affiliation(s)
- Nino Guarino
- Division of Pediatric Urology, Ospedale Infantile Regina Margherita, Turin, Italy.
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Damen-Elias HAM, Stoutenbeek PH, Visser GHA, Nikkels PGJ, de Jong TPVM. Concomitant anomalies in 100 children with unilateral multicystic kidney. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:384-388. [PMID: 15791588 DOI: 10.1002/uog.1851] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To determine the incidence and type of associated urogenital anomalies in children with a unilateral multicystic kidney and to assess in children with nephrectomy the additional diagnostic value of cystoscopy and, in girls, of colposcopy. METHODS This was a follow-up study of 100 fetuses with antenatally detected unilateral multicystic kidneys. After ultrasound confirmation of the diagnosis within a few days after birth voiding cystourethrography and isotope scan were performed in 83 of the surviving children to exclude vesicoureteral reflux and to establish renal function. Eighty-one children underwent nephrectomy and, prior to surgery, all underwent cystoscopy and girls also underwent colposcopy. RESULTS Seventy-five children had one or more additional urogenital anomalies: 39 had anomalies of the contralateral kidney, 40 had anomalies of the ipsilateral kidney and 30 had one or more anomalies of the lower urogenital tract. With cystoscopy 54 anomalies of the genitourinary tract were detected in 48 children and with colposcopy three anomalies were detected in 35 girls. Eighty-one children had a nephrectomy or heminephrectomy and 33 of them needed other urological intervention. Thirteen fetuses died (mostly from agenesis of the contralateral kidney) and six infants had no surgery at all. CONCLUSION Children with a unilateral multicystic kidney are at considerable risk of having other urogenital anomalies. When cystoscopy and colposcopy are added to routine investigations the rate of detection of anomalies is 75%, twice that reported in the literature.
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Affiliation(s)
- H A M Damen-Elias
- Department of Perinatology and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Acton C, Pahuja M, Opie G, Woodward A. A 5-year audit of 778 neonatal renal scans (Part 2). Miscellaneous anomalies in 59 infants: A pictorial presentation. ACTA ACUST UNITED AC 2003; 47:354-62. [PMID: 14641185 DOI: 10.1046/j.1440-1673.2003.01202.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this 5-year review of 778 neonatal renal scans seen in an obstetric hospital, Mercy Hospital for Women, Melbourne, most infants were referred because of antenatal ultrasound findings. Ninety-two percent of these had fetal pyelectasis. The results were classified on the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux found on micturating cystourethrogram. Persisting mild/moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. Review of these 59 infants illustrates the anomalies seen and reports the associated investigations and subsequent outcome in most cases.
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Affiliation(s)
- Christine Acton
- Department of Medical Imaging, Mercy Hospital for Women, East Melbourne, Victoria, Australia.
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