671 Multicystic dyplastic kidneys: outcomes for a paediatric population in Worcestershire

Résumé fourni par la source

Multicystic Dysplastic Kidneys (MCDKs) are a congenital abnormality characterised by a lack of functional or total lack of renal tissue and replacement by cysts. Since anomaly scans during pregnancy have become commonplace, diagnosis is usually antenatal. Traditionally, the MCDK was often removed due to concerns regarding malignant potential or hypertension.1 However, as it has become clearer that many of the MCDKs spontaneously involute and the risk of developing hypertension and malignancy is minimal, current recommendations advocate a watch and wait strategy.2–3 Objectives To evaluate the natural history and complications of MCDKs in our local population in Worcestershire. Methods Data was obtained retrospectively Ultrasound reports performed at Worcestershire Acute Hospital NHS Trust containing the key word ‘dysplastic’ performed in patients under the age of 16 were searched for. These were then further limited to those children found to have a MCDK on ultrasound, leaving a total of 38 patients with years of birth ranging from 2002 to 2019. Data was then collected from ultrasound reports, discharge summaries and clinic letters. Results 37 of the 38 patients were diagnosed antenatally. 52.6% of MCDKs were on the right. 12.5% patients had an additional renal tract congenital abnormality. The average frequency of ultrasound scan was 1 scan every 2 years: usually scans were conducted annually until involution and then less frequently (most commonly 3 yearly). 4 of the 38 patients underwent nephrectomy. 57.9% of patients had spontaneous involution of the MCDK, however 50% of the patients were still less than 9 years old at the time of data collection. Please see Figure 1. Average reduction in MCDK length per year was 18.3mm/year. Complications were rare: only 1 patient developed hypertension; there were only 6 documented UTIs for the entire population, no patients developed a malignancy and no patients developed proteinuria. Conclusions These results are consistent with the current consensus that MCDK is generally a benign condition in childhood and that the majority of MCDKs involute spontaneously. Limitations of this data are primarily the length of follow up for some of the patients. References Brown CT, Sebastião YV, McLeod DJ. Trends in surgical management of multicystic dysplastic kidney at USA children’s hospitals. Journal of Pediatric Urology 2019 Aug;15(4):368–73. Narchi H. Risk of hypertension with multicystic kidney disease: a systematic review. Archives of Disease in Childhood 2005 Sep 1;90(9):921–4. Narchi H. Risk of Wilms’ tumour with multicystic kidney disease: a systematic review. Archives of Disease in Childhood 2005 Feb 1;90(2):147–9.

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