Pediatric Nephrology

, Volume 34, Issue 2, pp 295–299 | Cite as

Necessity of performing voiding cystourethrography for children with unilateral multicystic dysplastic kidney

  • Kazuna Yamamoto
  • Koichi KameiEmail author
  • Mai Sato
  • Masao Ogura
  • Mari Suzuki
  • Yuichi Hasegawa
  • Katsuhiko Ueoka
  • Shuichi Ito
  • Kenji Ishikura
Original Article



The purpose of this study was to resolve the clinical question as to whether all patients with unilateral multicystic dysplastic kidney (MCDK) should receive voiding cystourethrography (VCUG).


This is a retrospective study using cross-sectional analysis. Seventy-five children with unilateral MCDK were enrolled, excluding patients with other genetic or chromosome abnormalities, spinal cord diseases, or anal atresia. We reviewed their records from medical charts and calculated risk factors for abnormal VCUG using multivariate logistic regression analysis.


Abnormal VCUG findings were present in 24 of 75 patients (32.0%), specifically, vesicoureteral reflux (VUR) in 8 (10.6%), including high-grade VUR in 2 (2.7%), and only lower urinary tract or bladder disease in 16 (21.3%). In multivariate analysis, only abnormal findings by ultrasonography was an independent risk factor for abnormal VCUG findings with statistical significance in multivariate analysis (OR 6.57; 95% CI 1.99–26.26; P = 0.002). When we excluded five patients who showed similar findings by ultrasonography and VCUG, abnormal findings by ultrasonography were again calculated as an independent risk factor (OR 4.44; 95% CI 1.26–28.42; P = 0.02). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal findings by ultrasonography to predict urologic anomalies by VCUG in these children were 83%, 59%, 49%, and 88%, respectively. Two children required a third ultrasonography to detect abnormal findings.


We can select, using only abnormal findings by ultrasonography, children with unilateral MCDK who should undergo VCUG. We would also like to emphasize that ultrasonography should be performed repeatedly to detect congenital anomalies of the urinary tract.


Multicystic dysplastic kidney (MCDK) Voiding cystourethrography (VCUG) Vesicoureteral reflux (VUR) Congenital anomalies of the kidney and urinary tract (CAKUT) Ultrasonography Children 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The design and execution of this study were in accordance with the ethical standards of the Declaration of Helsinki. The protocol was approved by the Ethics Committee of the National Center for Child Health and Development (No. 1372).

Informed consent

For this type of study, formal informed consent is not required.


  1. 1.
    Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 24:233–241CrossRefGoogle Scholar
  2. 2.
    Schreuder MF, Westland R, van Wijk JA (2009) Unilateral multicystic dysplastic kidney: a meta-analysis of observational studies on the incidence, associated urinary tract malformations and the contralateral kidney. Nephrol Dial Transplant 24:1810–1818CrossRefGoogle Scholar
  3. 3.
    Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (2010) Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 184:1134–1144CrossRefGoogle Scholar
  4. 4.
    Tekgul S, Riedmiller H, Hoebeke P, Kocvara R, Nijman RJ, Radmayr C, Stein R, Dogan HS, European Association of Urology (2012) EAU guidelines on vesicoureteral reflux in children. Eur Urol 62:534–542CrossRefGoogle Scholar
  5. 5.
    Stuck KJ, Koff SA, Silver TM (1982) Ultrasonic features of multicystic dysplastic kidney: expanded diagnostic criteria. Radiol 143:217–221CrossRefGoogle Scholar
  6. 6.
    The International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesicoureteral reflux. Pediatr 67:392–400Google Scholar
  7. 7.
    Uemura O, Honda M, Matsuyama T, Ishikura K, Hataya H, Yata N, Nagai T, Ikezumi Y, Fujita N, Ito S, Iijima K, Kitagawa T (2011) Age, gender, and body length effects on reference serum creatinine levels determined by an enzymatic method in Japanese children: a multicenter study. Clin Exp Nephrol 15:694–699CrossRefGoogle Scholar
  8. 8.
    Aubertin G, Cripps S, Coleman G, McGillivray B, Yong SL, Van Allen M, Shaw D, Arbour L (2002) Prenatal diagnosis of apparently isolated unilateral multicystic kidney: implications for counselling and management. Prenat Diagn 22:388–394CrossRefGoogle Scholar
  9. 9.
    Atiyeh B, Husmann D, Baum M (1992) Contralateral renal abnormalities in multicystic-dysplastic kidney disease. J Pediatr 121:65–67CrossRefGoogle Scholar
  10. 10.
    Selzman AA, Elder JS (1995) Contralateral vesicoureteral reflux in children with a multicystic kidney. J Urol 153:1252–1254CrossRefGoogle Scholar
  11. 11.
    al-Khaldi N, Watson AR, Zuccollo J, Twining P, Rose DH (1994) Outcome of antenatally detected cystic dysplastic kidney disease. Arch Dis Child 70:520–522CrossRefGoogle Scholar
  12. 12.
    Flack CE, Bellinger MF (1993) The multicystic dysplastic kidney and contralateral vesicoureteral reflux: protection of the solitary kidney. J Urol 150:1873–1874CrossRefGoogle Scholar
  13. 13.
    de Bruyn R, Gordon I (2001) Postnatal investigation of fetal renal disease. Prenat Diagn 21:984–991CrossRefGoogle Scholar
  14. 14.
    Ismaili K, Avni FE, Alexander M, Schulman C, Collier F, Hall M (2005) Routine voiding cystourethrography is of no value in neonates with unilateral multicystic dysplastic kidney. J Pediatr 146:759–763CrossRefGoogle Scholar
  15. 15.
    Kuwertz-Broeking E, Brinkmann OA, Von Lengerke HJ, Sciuk J, Fruend S, Bulla M, Harms E, Hertle L (2004) Unilateral multicystic dysplastic kidney: experience in children. BJU Int 93:388–392CrossRefGoogle Scholar
  16. 16.
    Hayes WN, Watson AR, Trent and Anglia MCDK Study Group (2012) Unilateral multicystic dysplastic kidney: dose initial size matter? Pedatr Nephrol 27:1335–1340CrossRefGoogle Scholar
  17. 17.
    Calaway AC, Whittam B, Szymanski KM, Misseri R, Kaefer M, Rink RC, Karymazn B, Cain MP (2014) Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary? Can J Urol 21:7510–7514PubMedGoogle Scholar
  18. 18.
    Feldenberg LR, Siegel NJ (2000) Clinical course and outcome for children with multicystic dysplastic kidneys. Pediatr Nephrol 14:1098–1101CrossRefGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  • Kazuna Yamamoto
    • 1
    • 2
  • Koichi Kamei
    • 1
    Email author
  • Mai Sato
    • 1
  • Masao Ogura
    • 1
  • Mari Suzuki
    • 3
  • Yuichi Hasegawa
    • 3
  • Katsuhiko Ueoka
    • 3
  • Shuichi Ito
    • 1
    • 4
  • Kenji Ishikura
    • 1
  1. 1.Division of Nephrology and RheumatologyNational Center for Child Health and DevelopmentTokyoJapan
  2. 2.Division of PediatricsShiga University of Medical ScienceOtsuJapan
  3. 3.Division of UrologyNational Center for Child Health and DevelopmentTokyoJapan
  4. 4.Department of Pediatrics, Graduate School of MedicineYokohama City University School of MedicineYokohamaJapan

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