PD4-09 MULTICYSTIC DYSPLASTIC KIDNEY: IMPACT OF IMAGING MODALITY SELECTION ON THE INITIAL EVALUATION AND PROGNOSIS

Abstract

You have accessJournal of UrologyImaging/Radiology I1 Apr 2014PD4-09 MULTICYSTIC DYSPLASTIC KIDNEY: IMPACT OF IMAGING MODALITY SELECTION ON THE INITIAL EVALUATION AND PROGNOSIS Mustafa Alghanbar, Osama Sarhan, Abdulhakim Alotay, and Ziad Nakshabandi Mustafa AlghanbarMustafa Alghanbar More articles by this author , Osama SarhanOsama Sarhan More articles by this author , Abdulhakim AlotayAbdulhakim Alotay More articles by this author , and Ziad NakshabandiZiad Nakshabandi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.230AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multicystic dysplastic kidney (MCDK) is the most common cystic renal lesion in children. Nowadays, most cases are detected antenatally by ultrasound screening. However, postnatal renal bladder ultrasound (RBUS) will be required to establish the diagnosis. In addition, Technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy or voiding cystourethrogram (VCUG) may be performed to confirm the diagnosis, and screen for vesicoureteral reflux (VUR), respectively. METHODS We retrospectively reviewed the charts of all children with MCDK diagnosed at our hospital from 2004 until 2012. We included 63 patients in whom postnatal evaluation included RBUS, DMSA and VCUG. We evaluated the necessity of DMSA scan for confirming the diagnosis and VCUG for screening of VUR. Additionally the fate of MCDK was evaluated. RESULTS The average age of the children at the time of diagnosis was 4.5 months. The majority of cases were detected antenatally (87%). Postnatal RBUS established the diagnosis of MCDK in 92% of patients. Abnormalities on the contralateral kidney were detected in 11 patients (17%). The association of VUR with hydronephrotic contralateral kidneys was 62%. Contralateral VUR was diagnosed in 16 patients (25%); most of them were of lower grade. DMSA scan verified absent function in the affected kidney in 62 of the 63 patients (98%). It also showed photopenic areas in the contralateral kidneys in 6 patients (10%), all of them had hydronephrosis on initial renal ultrasound and confirmed to have VUR by VCUG. Follow up ranged from 1 to 9 years (mean of 3.5). Fate of the MCDK included involution in 39 patients (62%), and the involution rate was inversely proportional to the initial size. Ipsilateral nephrectomy was necessary in 3 patients (5%) while 33% continued to be followed up conservatively for unchanged appearance. On follow up, chronic kidney disease (CKD) developed in 2 (3%) and hypertension in 1 (2%) patients, respectively. No patients developed any neoplastic changes. CONCLUSIONS In our experience, the classical appearance of MCDK on the initial RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered and carefully managed. Ipsilateral nephrectomy was not required in most patients with MCDK. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e54 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mustafa Alghanbar More articles by this author Osama Sarhan More articles by this author Abdulhakim Alotay More articles by this author Ziad Nakshabandi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...