449 CAN WE ELIMINATE THE SCREENING VOIDING CYSTOURETHROGRAM IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY?

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012449 CAN WE ELIMINATE THE SCREENING VOIDING CYSTOURETHROGRAM IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY? Beth Drzewiecki, Douglass Clayton, John Thomas, John Pope, Mark Adams, John Brock, and Stacy Tanaka Beth DrzewieckiBeth Drzewiecki Nashville, TN More articles by this author , Douglass ClaytonDouglass Clayton Nashville, TN More articles by this author , John ThomasJohn Thomas Nashville, TN More articles by this author , John PopeJohn Pope Nashville, TN More articles by this author , Mark AdamsMark Adams Nashville, TN More articles by this author , John BrockJohn Brock Nashville, TN More articles by this author , and Stacy TanakaStacy Tanaka Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.517AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our understanding of both multicystic dysplastic kidney(MCDK) and vesicoureteral reflux(VUR) has increased significantly over the years and therefore management continues to evolve. While reflux nephropathy in a solitary kidney can be devastating, the natural history of VUR in MCDK is primarily that of resolution. The current guidelines regarding VUR do not address children with a solitary kidney. We sought to determine role of screening VCUG in patients diagnosed with MCDK. METHODS We retrospectively reviewed the charts of all patients with a diagnosis of MCDK (ICD9 753.19) between January 1, 2000 and July 31, 2010. 210 patients were identified as having a diagnosis of MCDK and only 2 did not have a screening VCUG. Information including gender, screening VCUG, grade of reflux, location of reflux (contralateral vs ipsilateral), febrile UTI, resolution of VUR or surgical intervention, and indication for surgery was obtained. Kaplan-Meier survival analysis was performed to evaluate outcomes of contralateral reflux over time. RESULTS A total of 208 children (54% male and 46% female) included in the analysis. Documented VUR on either side was found in 51 (25%) of patients. Contralateral VUR was found in 37 (18%) of children with MCDK, of whom 8 had bilateral VUR. Median follow up of patients with contralateral VUR was 30.1 months (range 6.2-97.7). Clinically significant VUR was seen in 3 patients (1.4%) as noted by nephropathy (1) and febrile UTI (2). Nine patients underwent surgical correction for contralateral VUR, one of whom had endoscopic correction only. Indications for surgery included nephropathy (1), febrile UTIs (2), and concern for reflux in solitary kidney (6). Resolution in the children observed was documented by radiologic study in 18, of whom 12 had high grade VUR(grade III-V). Median time to resolution was 16.5 months (range 10.6 to 53). On Kaplan-Meier analysis, there is an 80% likelihood of children not requiring surgical intervention for contralateral VUR at 48 months. CONCLUSIONS Overall, 208 VCUGs were performed to detect clinically significant VUR in 1.4% of patients. Children with MCDK and contralateral VUR have a low likelihood of febrile UTI and excellent chance of resolution of even high grade VUR. Abnormal post natal ultrasound should still warrant investigation for VUR. Parents should be cautioned on the risks of UTIs in a solitary kidney and that any febrile illness should warrant urinary evaluation for infection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e184 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Beth Drzewiecki Nashville, TN More articles by this author Douglass Clayton Nashville, TN More articles by this author John Thomas Nashville, TN More articles by this author John Pope Nashville, TN More articles by this author Mark Adams Nashville, TN More articles by this author John Brock Nashville, TN More articles by this author Stacy Tanaka Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...