Outcomes of Children with Multicystic Dysplastic Kidney in University Children’s Hospital in Damascus

Abstract

Abstract

Background & Objective: Unilateral multicystic dysplastic kidney (MCDK) is one of the commonest abnormalities detected by antenatal ultrasound. The MCDK is nonfunctional, The contralateral kidney shows compensatory function, and the total renal function is normal, and the prognosis is good. Management of patients with MCDK has shifted from routine nephrectomy to observation and medical therapy. This study aimed to evaluate the clinical course of MCDK, and the outcomes of the conservative management, to ensure that routine nephrectomy is not necessary.

Materials & Methods: Descriptive cohort study carried out in Children’s Hospital in Damascus, included all patients admitted in a period of 10 years, from January 2008 to October 2017, with diagnosis of MCDK. We collected the data, which were discussed and compared with similar  studies in the literature.

Results: The study includes 79 patients had MCDK, with male dominance (62%), 53% of the cases were detected by prenatal ultrasound evaluation , it was slightly more common on the left side (53%). We reported  Vesicoureteral Reflux in 16.5% in the contralateral side , and in 4% in the ipsilateral side, and  Ureteropelvic junction obstruction was the next most common anomaly in the contralateral renal system, accounting for 5% of cases. After follow up for one year at least in all patients, the clinical course of simple Unilateral MCDK without additional urinary abnormalities was normal without complications in 96% of cases, whereas in complex MCDK with additional urinary abnormalities, we reported complications in 50% of cases. Nephrectomy rate was decreasing during study period.

Conclusion: Unilateral MCDK without additional urinary abnormalities has normal clinical course and good prognosis. Surgical resection of the MCDK appears to be controversial and difficult to justify with the evidence-based results. Management of patients with MCDK has shifted to observation and conservative therapy. We need future multicenter studies to identify the period  and the strategy of the observation of MCDK.