MCDK in neonate 2016 Flashcards
what is the initial management of MCDK?
non-surgical approach
is there a risk of WT in MCDK? should patient with MCDK be surveyed for WT?
No, No
Should kids with MCDK be monitored for HTN?
Yes, and if identified and no other cause is known consideration can be given to a curative nephrectomy as per reports in literature
what are simple and complex MCDK?
“Simple” is defined as: unilateral dysplasia
with a normal contralateral kidney with
compensatory hypertrophy and no associated
genitourinary anomalies detected by
US or physical examination
“Complex” is defined as: bilateral dysplasia
or abnormalities of the contralateral
kidney or genitourinary tract detected by
US or physical examination
what is the risk of ESRD in simple and complex MCDK?
simple nil at 5 years
complex is 20-30%
Do kids with MCDK need to be monitored for HTN, renal function and proteinuria?
yes per nephrological literature but doesn’t have to be by a urologist necessarily.
are people with MCDK at higher risk of VUr than general populaiton?
yes, having US abnormalities in the contralateral kidney is predictive ( but not if the anomaly is hydro nephrosis)- people with complex MCDK are at higher risk
Who has the highest risk of of UTI? simple or complex MCDK
Complex MCDK
Is there a risk for adult malignancies to develop in MCDK? what if it has not involuted?
Based on the literature, there is potential for an adult malignancy
to develop in a MCDK. This risk appears to be very
low considering the majority of persons currently over the
age of 35 years born with a MCDK did not have it removed.
There is no evidence to suggest that this risk is higher in
MCDKs that have failed to undergo radiographic involution
(new)
what are male and female anomolies associated with solitary kidney
unilateral and bilateral absence of VD
uterus didelphys and obstructive hemivagina
IS there any special imaging recommended for males or females with MCDK when they hit puberty?
yes females should get an US after thelarche
not for males
what can the MCDK be mixed up with?
UPJO. in cases where it is difficult to diagnose based on US, renal scan showing lack of function is supportive of MCDK but presence of some function don’t rule it out
what are the 3 things the urologists needs to do for patients with MCDK?
Confirm the diagnosis
Use judgment to decide if a VCUG is needed
Determine if MCDK is simple or complex and manage it accordingly
How is simple MCDK diagonsed?
initial US and then a repeat at 12-24 months to confirm compensatory hypertrophy. those with simple MCDK dont require further FU with urology, FU with peds or nephro re protienuria and HTN, counsel parents on sports and solitary kidneys, suggest US at puberty for girls
