ESPN 50th Annual Meeting

ESPN 2017


 
IS ROUTINE VOIDING CYSTOURETHROGRAPHY NECESSARY IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY DISEASE?
NURDAN YILDIZ 1 HARIKA ALPAY MEHTAP SAK 1 IBRAHIM GOKCE 1

1- MARMARA UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY
 
Introduction:

 Multicystic dysplastic kidney(MCDK) is the most common cause of cystic kidney diseases in children. Voiding cystourethrography(VCUG) in patients with MCDK was performed routinely to detect vesicoureteral reflux(VUR) which is the most common associated contralateral renal abnormality. However, the routine use of VCUG is currently controversial.

 

We aimed to evaluate the necessity of routine VCUG in patients with MCDK.

Material and methods:

Eighty seven children(27 girls, 60 boys) with MCDK followed-up at our pediatric nephrology outpatient clinic were included in the study. Ultrasonography(USG), Tc99DMSA scan, Tc99MAG3 scans and VCUG findings, clinical and laboratory data were retrospectively evaluated.

Results:

The mean age of the patients were 9.59±7.1 (2-23)  years. Antenatal hydronephrosis or MCDK was diagnosed in 71 (81.6%) patients. Seventy-four patients (%85) were diagnosedMCDK within the first month of life.
Six(6.9%) patients had grade 1-3 and 4(4.6%) had grade 4-5 VUR in contralateral kidney. Bilateral VUR was present in two(2.3%) patients. Voiding cystourethrography was not performed in 14 patients. None of these patients had hydronephrosis and/or urinary tract infection(UTI). At the follow-up, four patients with VUR underwent ureteral reimplantation and endoscopic subureteric injection was performed in four patients. 
Nine of VUR patients had UTI and/or hydronephrosis. Three patients with VUR were asymptomatic. Two of them followed-up conservatively and surgical intervention was performed in one patient. Hydronephrosis and/or UTI in patients with VUR were significantly higher than the patients without VUR(p=0.0001).

Ureteropelvic junction stenosis(one obstructive and two non-obstructive) of the solitary kidney was found in three patients, they all were detected postnatally. Eighty seven children(27 girls, 60 boys) with MCDK followed-up at our pediatric nephrology outpatient clinic were included in the study. Ultrasonography(USG), Tc99DMSA scan, Tc99MAG3 scans and VCUG findings, clinical and laboratory data were retrospectively evaluated.

Conclusions:

Routine VCUG in healthy children diagnosed with unilateral MCDK is not necessary in those children without UTI and/or contralateral hydronephrosis.

Families should be informed about the signs and symptoms of urinary tract infection and selective screening for VUR should be considered only for patients with contralateral abnormality and/or patients with UTI.