Diagnosis Of Multicystic Dysplastic Kidney Research Articles

A rare case report: Renal coloboma syndrome

Renal coloboma syndrome (RCS), also called papillorenal syndrome, is a rare syndrome characterized by renal abnormalities and optic nerve dysplasia. We present a case of a neonate with renal and eye abnormalities. Along with the known diagnosis of multicystic dysplastic kidney, the neonate was diagnosed with coloboma of the right eye, making a probable diagnosis of RCS. Retinal detachment and decreased visual acuity are implications of the ocular malformations. Hypertension, proteinuria, and renal insufficiency, which frequently lead to end-stage kidney disease, are serious consequences of renal dysplasia.

Prenatal diagnosis of multicystic dysplastic kidney with contralateral pelviureteric junction obstruction on ultrasound

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Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney.

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. 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. 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). 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.

Association of Wilms tumor in multicystic dysplastic kidneys: case report and review of the literature

Multicystic dysplastic kidney is a rare urinary anomaly characterized by multiple non-communicating cysts resulting in a non-functional kidney. In addition to association with hypertension and contralateral renal anomalies, children with multicystic dysplastic kidney have an increased risk of Wilms tumor. Cohort studies and systematic reviews are hampered in estimating the true risk of this association due to the rarity and infrequent reporting of the condition. We present a case of a 2-year-old male child with an antenatal diagnosis of multicystic dysplastic kidney undergoing surveillance ultrasonography who presented with a symptomatic Wilms tumor. Level of evidence: Not applicable for this multicentre audit.

Trends in surgical management of multicystic dysplastic kidney at USA children's hospitals

Multicystic dysplastic kidney (MCDK) is a congenital renal cystic disease often incidentally diagnosed in children. Historically, children with MCDK underwent early nephrectomy because of concerns for the development of hypertension or malignancy. Over the last decade, management recommendations have not supported routine early surgical removal of MCDK. The study authors sought to determine the current trends in the use of nephrectomy for MCDK in US children's hospitals because national practice patterns have not been investigated. A population-based retrospective cohort study using the Pediatric Health Information System (PHIS) was conducted. The study population was comprised of patients aged 0-18 years with a diagnosis of MCDK (International Classification of Diseases-9th revision, code 753.19) admitted to the inpatient department of the study hospital between January 2006 and September 2015. Patients with additional renal anomalies including polycystic kidney, medullary cystic kidney, and medullary sponge kidney were excluded, as were patients treated in a hospital that did not contribute data to the PHIS continuously throughout the study period. Trends in the annual proportion of nephrectomies performed were analyzed among admissions in the study population, along with patient clinical and demographic information. A total of 3792 MCDK admissions, in 34 hospitals, were included in the study. Overall, 569 nephrectomies were performed during the study period. The proportion of nephrectomy decreased annually by 9.2% on average, from 22.1% in 2006 to 7.3% in the first 3 quarters of 2015. No significant trends were observed in the annual number of overall MCDK admissions or patient age at procedure among patients who had a nephrectomy. Among nephrectomies, 84.2% were open and 15.8% were minimally invasive procedures (laparoscopic non-robotic, 10% and robotic, 5.8%). The proportion of minimally invasive nephrectomies increased annually by 13.7%, from 8% in 2006 to 29% in 2015. Trends in the use of nephrectomy for MCDK at a national level have not been previously reported. This study is limited by the use of inpatient discharge data, which did not allow estimating the true rate of nephrectomy in patients born with MCDK. During the study period, there has been a decrease in the use of nephrectomy for MCDK in pediatric hospitals, along with a concurrent increase in utilization of minimally invasive techniques to perform nephrectomies. These results suggest that in general, urologists at freestanding children's hospitals are heeding recommendations for observation and against routine early surgical removal of these kidneys; although trends in the use of nephrectomy varied between hospitals, there is room for continued improvement in following these recommendations.

Renal cyst evolution in childhood: a contemporary observational study

Children with renal cysts often undergo ultrasound (US) monitoring to identify malignant transformation or polycystic kidney disease (PKD). However, the utility of ongoing surveillance is uncertain. The objective of this study was to assess the natural history of simple or minimally complex cysts and the proportion of progression to autosomal dominant polycystic kidney disease (ADPKD), autosomal recessive polycystic kidney disease (ARPKD), or malignancy. The institutional review board approved retrospective chart review at one institution between 2004 and 2014. Eligible patients had ≤3 simple or minimally complex cyst(s) discovered on US without an initial diagnosis of multicystic dysplastic kidney, genitourinary malignancy, ADPKD, or ARPKD. Patient demographics and cyst details were recorded at identification and follow-up visits. Logistic regression was used to examine univariate association between diagnosis of ADPKD/ARPKD and each recorded variable. Eighty-seven eligible patients were identified. Twenty-two patients were identified antenatally or in the first year of life; the remaining 65 were identified at >1 year of age, median 7.6 years (interquartile range [IQR]: 4.2, 10.6). Most (60/87, 69%) had a solitary cyst at initial US. The median length of follow-up was 4.1 years (IQR: 1.9, 6.8) with median 3 follow-up US (IQR: 2, 5). Eleven patients (12.6%) were diagnosed with ADPKD. One patient (1.2%) was diagnosed with ARPKD. A median 2 follow-up US (IQR: 1, 4) procedures were performed over a median of 2.2 years (IQR: 1.0, 3.9) to obtain diagnoses of ADPKD or ARPKD. No patients developed malignancy. This study's results reveal that children identified to have a small number of simple or minimally complex renal cysts on initial US are unlikely to require additional treatment for these cystsas transformation to PKD or malignant condition is rare. Supporting this are results from literature that although simple cysts in childhood may evolve over time, most do not require any surgical or invasive treatment in the long term. Limitations include retrospective design and single institution. Autosomal dominant polycystic kidney disease/autosomal recessive polycystic kidney disease diagnosis occurs early in follow-up evaluation in children with simple or minimally complex cysts. Malignant transformation did not occur in any patients in this study. This study examines the natural history of renal cysts in childhood. Following up simple renal cysts routinely beyond 2-3 years after initial detection may not be optimal due to the use of limited medical resources.

Diagnostic accuracy of midtrimester antenatal ultrasound for multicystic dysplastic kidneys.

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. 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. 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. 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.

Differential diagnosis of multicystic dysplastic kidney and nephroblastoma

В статье представлен клинический случай, описывающий трудности лучевой и интраоперационной дифференциальной диагностики нефробластомы и мультикистозной почечной дисплазии у ребенка.

Multicystic dysplastic kidney: a retrospective study.

To report the renal structural and functional anomalies in children with multicystic dysplastic kidneys. Retrospective descriptive analysis of 47 children with multicystic dysplastic kidney seen in a pediatric nephrology unit over a period of 6 years. Antenatal diagnosis of multicystic dysplastic kidney was made in 34 (72.3%) patients. On follow up of 31 children for more than 12 months, 21 (68%) had involution, 4 [13%] had non-regression, and 4 (13%) were nephrectomized. Vesico-ureteric reflux (n=13; 28%) was the commonest renal abnormality. The serum creatinine values were higher (P=0.006) in children with contralateral reflux. Sub-nephrotic proteinuria was noted in 9 (29%) and was significantly associated with complete involution (P=<0.023). None of the patients developed hypertension and 2 (6.4%) had renal failure. Close nephrological follow-up is needed in children with multicystic dysplasia of kidneys.

Ultrasound diagnosis of multicystic dysplastic kidney: Is a confirmatory nuclear medicine scan necessary?

ObjectiveIt is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with severe hydronephrosis as the treatment varies significantly. We designed a study to compare renal ultrasound (RUS) to nuclear medicine (NM) scan in the diagnosis of MCDK, in order to determine if RUS can be used for the definitive diagnosis of MCKD without use of NM scan. Materials and methodsWe performed a retrospective review of children with MCDK, who underwent both a RUS and Tc-99m MAG3 or DMSA scan. We planned to calculate the positive predictive value of an RUS diagnosis of MCDK, using NM scan diagnosis of a nonfunctioning kidney as the gold standard. ResultsThe diagnosis of MCDK was made by RUS in 91 patients, 84 of whom had a normal bladder US. NM confirmed the diagnosis of MCDK in all 84 of these patients (100%). ConclusionWe have demonstrated a high predictive value for RUS in the diagnosis of MCDK. Our data support that in healthy infants with RUS diagnosis of unilateral MCDK and normal bladder US, NM scan may be unnecessary to confirm the diagnosis.

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

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 ...

Microalbumin excretion and outcome in children with multicystic dysplastic kidney

To present the long-term follow-up results of children with multicystic dysplastic kidney (MCDK) and urinary microalbumin excretion levels in order to evaluate whether there is an increased risk of renal damage or not. Materials and methods: Thirty-three children with the diagnosis of MCDK who had been followed up by the nephrology outpatient clinic between 2002 and 2009 were invited to participate in the study. Twenty-six healthy children were investigated as a control group for microalbumin/creatinine ratio (µg/g creatinine). The mean age at diagnosis, the duration of follow-up, accompanying urinary tract abnormalities, attacks of urinary tract infection (UTI), contralateral kidney size, and urinary microalbumin levels were investigated. Results: The mean age of the patients with MCDK and the mean duration of follow-up were 6.5 ± 3.9 years and 35 months (range 2-96) months, respectively. The most common urinary tract abnormality was vesicoureteral reflux (VUR), with a rate of 34%. Thirty-nine percent of the children experienced UTI during follow-up. The compensatory renal hypertrophy of the contralateral kidney was 24% at 6 months and 68% at 12 months. Sixteen patients (59%) had an increased microalbumin/creatinine ratio (>30 µg/mg creatinine). Microalbumin/creatinine ratio was higher in patients with MCDK than it was in the controls (P = 0.001). Conclusion: Microalbuminuria and VUR are not rare in children with MCDK. Systematic follow-up of these patients is recommended to identify those at risk of contralateral renal damage.

Comparison of Ultrasound and Magnetic Resonance Urography for Evaluation of Contralateral Kidney in Patients With Multicystic Dysplastic Kidney Disease

The contralateral kidney is abnormal in up to 25% of patients with multicystic dysplastic kidney. Traditionally, anatomical and functional evaluation of the contralateral kidney has been performed with ultrasound and dimercapto-succinic acid renal scintigraphy, as indicated. Recently magnetic resonance urography has been used to evaluate renal anatomy and function in other urological abnormalities. We compared the results of magnetic resonance urography and ultrasound for evaluating the contralateral kidney in patients with multicystic dysplastic kidney and we describe the range of findings detected. Patients with multicystic dysplastic kidney who underwent magnetic resonance urography were identified. Anatomical findings on magnetic resonance urography were analyzed and compared to those on renal ultrasound. Additional functional information derived from magnetic resonance urography was also recorded. We retrospectively identified 58 patients with a unilateral multicystic dysplastic kidney who had undergone magnetic resonance urography, of whom 54 also underwent ultrasound. Of the patients 19 (32.8%) had a contralateral abnormality. A discrepancy between magnetic resonance urography and ultrasound was seen in 9 patients (16.7%). Of these patients only 1 had a completely normal contralateral kidney by ultrasound on retrospective review. The incidence and range of parenchymal abnormalities was wider than previously reported. Contralateral abnormalities in children with multicystic dysplastic kidney are common and more definitively evaluated with magnetic resonance urography vs ultrasound. Renal ultrasound remains the most appropriate modality for the initial evaluation of children with multicystic dysplastic kidney, and magnetic resonance urography is recommended when a functional study is required either to confirm the diagnosis of multicystic dysplastic kidney or to evaluate suspected abnormalities of the contralateral kidney.

Multicystic Dysplastic Kidney Disease Presenting With a Single Large Cyst in a Fetus–Anatomical Basis and Radiological Aspects

Multicystic dysplastic kidney (MCDK) is a congenital maldevelopment in which the renal cortex is characteristically replaced by numerous cysts of multiple sizes. MCDK presenting as a single predominant large cyst in morphology is less common. We report on the prenatal imaging findings and perinatal management of a fetus with MCDK unusually presenting as a single predominant large cyst, erroneously interpreted as a severe fetal hydronephrosis. Details of the perinatal history, radiological evaluation, morphological characteristic, and clinical aspect of this case are presented. We also discuss a few studies addressing the sensitivity of magnetic resonance urography for the prenatal diagnosis of MCDK.

Long-term risk of chronic kidney disease in unilateral multicystic dysplastic kidney

The clinical spectrum of renal dysplasia includes the non-functioning multicystic dysplastic kidney (MCDK). We report our experience of the outcome of unilateral MCDK and its contralateral kidney in 101 children with the diagnosis of MCDK from 1985 to 2009. Data collected included urine protein/creatinine ratio, estimated GFR (eGFR), blood pressure, surgical intervention, renal length and abnormalities of the contralateral kidney, and the involution rate. There was a predominance of left-sided MCDK. Diagnosis was made prenatally in 86.7%. Contralateral abnormalities included vesicoureteral reflux (16.8%), UPJ obstruction (4.1%), and megaureter (2.4%). Complete involution of MCDK occurred within 5 years in 60%. Compensatory hypertrophy of the contralateral kidney to >97% occurred in 74.1%. Nephrectomy was performed in 19.8%. There was an increased risk of chronic kidney disease (CKD) stage ≥ 2, and hypertension in those with contralateral abnormalities (p<0.0001; p<0.001 respectively). In those without contralateral abnormalities, hyperfiltration with mean eGFR of 149 ± 13 ml/min/1.73 m(2) was seen in 32% and proteinuria in 9.8%. There was a significantly inverse relationship between proteinuria and eGFR (p<0.0001). In conclusion, children with contralateral abnormalities are at risk for developing decreased kidney function, whereas a substantial number of patients with no obvious contralateral abnormalities have markers of renal injury. Therefore, systematic follow-up of all patients is recommended.

Riñón multicístico: Evaluación del riñón contralateral

A multicystic dysplastic kidney (MCDK) is often associated with contralateral kidney abnormalities. Medical records of 34 children with a diagnosis of MCDK were retrospectively analized for contralateral kidney abnormalities and global renal function. They were examined using ultrasound, isotope scan with Tc-99m dimercaptosuccinic acid (Tc-99 DMSA) and voiding cystouretrogrphy (VUG). Abnormalities of the contralateral kidney were found in 11/34 (32%). The most common being ureteropelvic junction obstruction and vesicoureteral reflux. In five patients follow-up revealed renal dysplasia, of these one developed hypertension. No malignancy was found. Based on the results of this study we recommend a complete evaluation of the contralateral kidney using ultrasound, Tc-99 DMSA and VUG. Regular follow-up must be performed, evaluating serum creatinine levels and kidney growth for the early detection and treatment of chronic renal failure.

The Importance of Accurate Diagnosis and Early Close Followup in Patients With Suspected Multicystic Dysplastic Kidney

Purpose Conservative management of children who have unequivocal multicystic dysplastic kidney with a stable or regressive pattern of disease during close followup is well established. However, a clear diagnosis may prove difficult. We report 3 cases in which the diagnosis was particularly difficult to increase awareness of the importance of applying strict criteria for the diagnosis of multicystic dysplastic kidney. Materials and Methods Three children in whom a diagnosis of multicystic dysplastic kidney was suspected underwent surgical exploration. One patient who did not comply with followup presented with a large retroperitoneal mass suspicious for neuroblastoma 8 months later. In another patient a growing renal cystic mass was suspicious for a multilocular cyst at 3 months of followup. At 2 months of followup a cystic nephroma was suspected in the remaining patient. Results All patients underwent surgical exploration. The patient with suspected neuroblastoma had extensive stage 3 Wilms tumor. In the child with a suspected multilocular cyst segmental multicystic dysplastic kidney of the lower pole of an ipsilateral duplicated system was found. In the patient in whom cystic nephroma was suspected mesoblastic nephroma was confirmed by the National Wilms Tumor Study Pathology Center. Conclusions An unequivocal diagnosis of multicystic dysplastic kidney should be made early in life. The urologist should have an active role in making the initial radiological diagnosis and close followup with renal ultrasound every 3 to 4 months is essential during year 1 of life. Surgical exploration is indicated if the diagnosis becomes equivocal at any point or should concerns exist regarding compliance with followup.

Ultrasonographic evaluation of multicystic dysplastic kidney.

Eleven cases of multicystic dysplastic kidney (MCDK) in children were diagnosed over an 11 year period. All underwent postnatal ultrasound (US) studies. Four different patterns of MCDK were recognized: (1) Six cases presented with the classic sonogram of multicystic components. (2) Three cases had hydronephrotic form; correct diagnosis between hydronephrotic form of MCDK and hydronephrosis was difficult as there was a medially-located, large, lobulated cyst and there was connection between the large cyst and neighboring small cysts. (3) One case initially presented with normal renal sonogram but a small cyst appeared on follow up sonogram and there was also decreased renal size and increased echogenecity. (4) One case had only two moderate-sized cysts but no identifiable renal parenchyma. Two cases had follow-up US examination and one dysplastic kidney decreased in renal size on follow-up sonogram. Intravenous urography and radionuclide study revealed both these dysplastic kidneys to be nonfunctioning. Nine children had surgical resection of the diseased kidneys. Contralateral renal anomalies were detected in five children, which included ureteropelvic junction stenosis, ureterovesical junction stenosis, distal ureteral stenosis and polycystic kidney disease. Two of three hydronephrotic forms of MCDK had contralateral ureteral stenosis. Two of six classic forms of MCDK had contralateral ureteral stenosis. The proportion of contralateral ureteral stenosis was higher in the group of hydronephrotic forms of MCDK. Ultrasonography is beneficial for conclusive diagnosis of MCDK; however, a differential diagnosis of simple hydronephrosis needs to be considered.

Renal agenesis: An acquired condition?

Renal agenesis is a relatively common congenital anomaly, although its etiology is unknown. It is clear that some solitary kidneys are the result of postnatal involution of multicystic dysplastic kidneys. The authors present a series of nine neonates with abnormal prenatal renal ultrasound findings; subsequent postnatal investigations showed an absent kidney. Five children had a prenatal diagnosis of multicystic dysplastic kidney (MDK) and two of hydronephrosis. In five cases (56%) there was a contralateral renal unit anomaly. It appears that MDK, and occasionally hydronephrosis, can involute prenatally, producing the postnatal appearance of renal agenesis.

Hypertension as a complication of multicystic dysplastic kidney

The detection of multicystic dysplastic kidney in utero using prenatal ultrasound is becoming a more frequent occurrence. An accurate diagnosis of multicystic dysplastic kidney usually can be made radiographically, and therefore the main indication for surgery in the asymptomatic patient may be the potential risk of complications developing later in life. We report hypertension as a complication of multicystic dysplastic kidney and review the literature.