Abstract
Background
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).
Methods
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.
Results
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.
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 24:233–241
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 24:1810–1818
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 184:1134–1144
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 62:534–542
Stuck KJ, Koff SA, Silver TM (1982) Ultrasonic features of multicystic dysplastic kidney: expanded diagnostic criteria. Radiol 143:217–221
The International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesicoureteral reflux. Pediatr 67:392–400
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 15:694–699
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 22:388–394
Atiyeh B, Husmann D, Baum M (1992) Contralateral renal abnormalities in multicystic-dysplastic kidney disease. J Pediatr 121:65–67
Selzman AA, Elder JS (1995) Contralateral vesicoureteral reflux in children with a multicystic kidney. J Urol 153:1252–1254
al-Khaldi N, Watson AR, Zuccollo J, Twining P, Rose DH (1994) Outcome of antenatally detected cystic dysplastic kidney disease. Arch Dis Child 70:520–522
Flack CE, Bellinger MF (1993) The multicystic dysplastic kidney and contralateral vesicoureteral reflux: protection of the solitary kidney. J Urol 150:1873–1874
de Bruyn R, Gordon I (2001) Postnatal investigation of fetal renal disease. Prenat Diagn 21:984–991
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 146:759–763
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 93:388–392
Hayes WN, Watson AR, Trent and Anglia MCDK Study Group (2012) Unilateral multicystic dysplastic kidney: dose initial size matter? Pedatr Nephrol 27:1335–1340
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 21:7510–7514
Feldenberg LR, Siegel NJ (2000) Clinical course and outcome for children with multicystic dysplastic kidneys. Pediatr Nephrol 14:1098–1101
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Yamamoto, K., Kamei, K., Sato, M. et al. Necessity of performing voiding cystourethrography for children with unilateral multicystic dysplastic kidney. Pediatr Nephrol 34, 295–299 (2019). https://doi.org/10.1007/s00467-018-4079-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-018-4079-z