Congenital Uropathies

Question 1

What is the natural history of multicystic dysplastic kidney? What is follow-up based on?

Answer 1

• Steadily involuting (47% by 5 years, 59% by 10 years)
• Follow-up based on the function of the contralateral kidney (normally unaffected)
• US at 2, 5, 10 years, monitor for proteinuria, BP

Question 2

What are the levels of obstruction that cause congenital pelvicaliceal dilation?

Answer 2

• Pelviureteric junction
• Ureterovesical junction
• Posterior urethral valve

Question 3

What is the most benign form of congential pelvicaliceal dilation? What kind of follow-up is warranted?

Answer 3

• Obstruction at the pelvoureteric junction
• US at 1/12, Mag 3 scan at 2-3/12
• Surgery only if the pelvis is > 30mm or renal function deteriorates

Question 4

What is the most concerning form of pelvicaliceal dilation? What kind of management might be warranted?

Answer 4

• Posterior urethral valve
• MCUG at birth, Mag 3 at 2-3 months.
• Often renal function is impaired and UTI risk high so consider IDC, cystoscopy, circumcision and antibiotic prophylaxis