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Alamir A, Al Rasheed SA, Al Qahtani AT, Almosa MS, Aljehani ND, Alanazi ED, Almutairi KA. The Outcome of Multicystic Dysplastic Kidney Disease Patients at King Abdulaziz Medical City in Riyadh. Cureus 2023; 15:e37994. [PMID: 37223165 PMCID: PMC10202889 DOI: 10.7759/cureus.37994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Background Multicystic dysplastic kidney (MCDK) is a type of kidney dysplasia consisting of many irregular, various-sized cysts divided by dysplastic renal tissue, which negatively impacts kidney function. MCDK is one of the most common renal congenital disorders seen in antenatal ultrasounds. The typical prognosis of MCDK is complete or partial involution that starts antenatally and continues postnatally. The aim of the study was to shed light on the overall outcome of patients with MCDK. Methods We retrospectively collected data on MCDK patients from 2016 until 2022 at King Abdulaziz Medical City, Ministry of National Guard Health Affairs in Saudi Arabia, Riyadh. The data included the recording of epidemiological data, radiological and laboratory reports, and the presence of urological or non-urologically associated anomalies. Results A total of 57 patients with MCDK were reviewed. Seven of them were excluded due to the diagnosis of bilateral MCDK, which was incompatible with life. Of the remaining 50 patients, the right kidney was affected in 52% of them. Most patients were diagnosed antenatally (98%). The mean duration of follow-up for the study was 48 months. Vesicoureteral reflux (VUR) was detected in 22% of the total sample. Overall, 90% of the patients underwent kidney involution. A small percentage had genitourinary anomalies (20%), while a larger percentage (48%) had extrarenal abnormalities. Conclusion Multicystic dysplastic kidney disease is relatively common in children. The prognosis is affected by the presence of genitourinary and non-genitourinary anomalies. Patients have an overall good prognosis with conservative management. Antenatal screening, diagnosis, and long-term nephrological follow-up are essential for the optimal management of patients.
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Affiliation(s)
- Abdulrahman Alamir
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Soud A Al Rasheed
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Abdullah T Al Qahtani
- Department of Pediatric Nephrology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Mohammad S Almosa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nawaf D Aljehani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Eid D Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid A Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary? Urology 2020; 139:156-160. [PMID: 32081673 DOI: 10.1016/j.urology.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having vesicoureteral reflux (VUR) or urinary tract infection (UTI) based on the US results. METHODS A retrospective chart review including children with unilateral MCDK with postnatal US and VCUG available at our institution between January 2008 and September 2017 was performed. Analysis was done to find association between abnormal contralateral US and contralateral VUR and UTI. RESULTS One hundred and fifty-six children were analyzed; 118(75.6%) patients had a normal contralateral kidney US, while 38(24.4%) had abnormal US. The rate of severe contralateral VUR (grade IV and V) was 2 (1.7%) and 5 (13.2%) in children with normal and abnormal contralateral US, respectively. The risk analysis demonstrated a significant association between severe VUR on the contralateral kidney and an abnormal contralateral US (odds ratio = 7.73; 95%CI: 1.43-41.81; P = 0.018) and no significant association with UTI (odds ratio = 1.58; 95%CI: 0.50-4.94; P = 0.435). CONCLUSION Our data suggests, the rate of severe contralateral VUR in children with unilateral MCDK and normal contralateral kidney is low. VCUG should be considered for infants with proven MCKD and alterations on the contralateral kidney on US. Following patients with MCDK and normal contralateral kidney without the use of VCUG is a reasonable approach, unless there is development of signs and symptoms of recurrent UTI or deterioration of the renal function. We found that abnormal contralateral kidney US was associated with severe VUR.
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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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Gaither TW, Patel A, Patel C, Chuang KW, Cohen RA, Baskin LS. Natural History of Contralateral Hypertrophy in Patients with Multicystic Dysplastic Kidneys. J Urol 2018. [DOI: 10.1016/j.juro.2017.06.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas W. Gaither
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Ankur Patel
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Chandni Patel
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Kai-wen Chuang
- Department of Urology, University of California, Irvine, Irvine, California
| | - Ronald A. Cohen
- Department of Diagnostic Imaging, UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | - Laurence S. Baskin
- Department of Urology, University of California, San Francisco, San Francisco, California
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Eickmeyer AB, Casanova NF, He C, Smith EA, Wan J, Bloom DA, Dillman JR. The natural history of the multicystic dysplastic kidney--is limited follow-up warranted? J Pediatr Urol 2014; 10:655-61. [PMID: 25087179 DOI: 10.1016/j.jpurol.2014.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Imaging of patients with multicystic dysplastic kidney (MCDK) has increased over the past three decades. This increased use of imaging has provided additional insights into the natural history of MCDK. The present study looked at this data for predictors of involution and associated anomalies. METHODS AND MATERIALS Institutional review board approval was obtained for this retrospective study. The University of Michigan Departments of Urology and Radiology records were searched to identify unilateral MCDK patients during 1980-2012. Available clinical, radiological and surgical records were reviewed, and pertinent data were recorded. The log-rank test and a Cox proportional regression analysis were performed to identify predictors of MCDK involution. Probability of involution over time was assessed using Kaplan-Meier methodology. RESULTS 301 unilateral MCDKs were identified; 195 (64.8%) were detected antenatally. Of the MCDKs found, 136 (45.2%) were in girls; 160 (53.2%) were right-sided. Mean size at baseline was 5.0 ± 0.2 cm (Mean ± SE). Associated abnormalities included: contralateral ureteropelvic junction obstruction (n = 10; 3.3%); contralateral ureterovesical junction obstruction/primary megaureter (n = 6; 2.0%); ipsilateral VUR (n = 21; 7.0%); contralateral VUR (n = 63; 20.1%); and renal fusion anomaly (n = 4; 1.3%). The cumulative probability of involution was: 9.8% at one year, 38.5% at five years, and 53.5% at ten years of age. Baseline MCDK size was the only significant predictor of involution at bivariate (p < 0.0001) and multivariate (p < 0.0001; HR 0.58 [95% CI: 0.49, 0.69]) analyses. No MCDK developed malignancy during the follow-up period. CONCLUSION As many MCDKs eventually involute and the risk of associated malignancy appears to be very low, there is no absolute indication for nephrectomy. Based on the data and other recent studies, it is believed that pediatric MCDK patients with no other urologic abnormalities can safely tolerate more limited urological and radiological follow-up.
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Affiliation(s)
- A B Eickmeyer
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - N F Casanova
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - C He
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - E A Smith
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - J Wan
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - D A Bloom
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - J R Dillman
- The University of Michigan, Departments of Urology and Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
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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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Tiryaki S, Alkac AY, Serdaroglu E, Bak M, Avanoglu A, Ulman I. Involution of multicystic dysplastic kidney: is it predictable? J Pediatr Urol 2013; 9:344-7. [PMID: 22687342 DOI: 10.1016/j.jpurol.2012.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the clinical course of multicystic dysplastic kidney (MCDK) and to reveal any criteria indicating spontaneous involution. MATERIAL METHODS Hospital records of patients with MCDK followed in two different institutions in 1994-2009 were reviewed and data were analyzed regarding involution. RESULTS Records of 96 patients were reviewed, of whom 46 were diagnosed antenatally and followed for more than 1 year. Fourteen patients had undergone nephrectomy. There was one case of hypertension which resided with nephrectomy. There was no malignancy. Involution rate was 53.6% (15/28) for right-sided and only 16.7% (3/18) for left-sided kidneys. The initial size of the kidney was found to be another predictive parameter for involution. Initial sizes of 43 (15 involuted and 28 non-involuted) kidneys were documented. Mean standard deviation score for involuting and non-involuting kidneys was -3.19 and 3.12, respectively. The chance of involution for a large kidney on the left was zero; however, involution risk for a small right-sided kidney was 67%. CONCLUSION Reviewing a 15-year period of our patient records conveyed data supporting current literature mainly encouraging non-operative management of MCDK. Further studies are required; however, our two objective indicators, the initial size and side of dysplastic kidney, may contribute to the management.
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Affiliation(s)
- Sibel Tiryaki
- Ege University, Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, Turkey
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Hayes WN, Watson AR. Unilateral multicystic dysplastic kidney: does initial size matter? Pediatr Nephrol 2012; 27:1335-40. [PMID: 22410799 DOI: 10.1007/s00467-012-2141-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We report the long-term follow-up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) who were followed between 1985 and 2009. METHODS Involution rates were documented over time based on the initial size of the MCDK, as documented on postnatal ultrasound (USS), as well as long-term complications and renal function. RESULTS In 323 patients (182 male), 10 % of MCDK had involuted, as evidenced on the first postnatal USS, with survival function analysis showing the probability of complete involution to be 35 % in 249 patients by 2 years of age, 47 % in 180 patients by 5 years of age and 62 % in 94 patients by 10 years of age. There was a significant difference in the involution rates of MCKD at the 10-year follow-up between MCDK with an initial size of >5 cm versus MCDK with an initial size of ≤5 cm (p < 0.0001). No patients in the whole cohort developed sustained hypertension or malignancy during a median follow-up of 10.1 years (range 0.3-15.4 years). Median estimated glomerular filtration rate (eGFR) in 76 patients (7 at 5 years, 69 at 10 years) was 93 ml/min/1.73 m(2) (range 46-175 ml/min/1.73 m(2)), with 40 (53%) having an eGFR of between 90 and 140 ml/min/1.73 m(2). Twenty-three (30 %) of the 76 patients at 10 years had normal eGFR (90-140 ml/min/1.73 m(2)) as well as complete involution of the MCDK, compensatory hypertrophy of the contralateral kidney, no proteinuria and no hypertension. CONCLUSIONS Larger MCDK at birth are less likely to involute during the first decade of life. However, conservative management remains justified due to the lack of complications. A minority of patients fulfil current criteria for discharge from specialty follow-up at 10 years.
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Affiliation(s)
- Wesley N Hayes
- Children's Renal & Urology Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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