Non-surgical management of multicystic dysplastic kidney.
ABSTRACT To better define the outcome and association of multicystic dysplastic kidney (MCDK) with hypertension, vesico-ureteric reflux (VUR), infection and cancer, as there is no consensus on the management of patients born with MCDK. The risk of cancer has dictated the surgical management of the disease in the past.
The Medline database was searched for articles published between 1965 and 2006 and written in the English language, and containing the keywords 'multicystic dysplastic kidney'.
The inclusion criteria were met by 105 reports that were subsequently analysed. Of MCDK, 60% regress or involute within 3 years. About 25% of patients will have VUR into the contralateral kidney, of which 90% is grade <or=3. The risk of urinary tract infection appears to be associated with VUR or coexistent abnormalities rather than the MCDK. The risk of hypertension is no greater than that in the general population and nephrectomy is usually not curative. The overall risk of Wilms' tumour developing in a MCDK is <1 in 2000. All reported Wilms' tumours were identified before 4 years of age and 70% presented as a palpable mass.
Published reports support the non-surgical management of MCDK. Common practice has been to remove palpable or growing MCDKs, although these represent a very small fraction of MCDKs. In theory, ultrasonographic surveillance until 4 years old might allow the earlier detection of a Wilms' tumour, and decrease the intensity of chemotherapy and improve prognosis. Previous reports do not prove or disprove this concept, and the appropriate frequency of surveillance is not evident.
Article: Neonatal Polycystic Kidney Disease[Show abstract] [Hide abstract]
ABSTRACT: This article provides an up-to-date comprehensive review and summary on neonatal polycystic kidney disease (PKD) with emphasis on the differential diagnosis, clinical manifestations, diagnostic techniques, and potential therapeutic approaches for the major causes of neonatal PKD, namely hereditary disease, including autosomal recessive and autosomal dominant PKD and nonhereditary PKD, with particular emphasis on multicystic dysplastic kidney. A brief overview of obstructive cystic dysplasia and simple and complex cysts is also included.Clinics in Perinatology 09/2014; 41(3). DOI:10.1016/j.clp.2014.05.005 · 2.13 Impact Factor
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ABSTRACT: Objective To evaluate the impact of imaging modalities on the evaluation and prognosis of children with multicystic dysplastic kidney (MCDK) disease. Patients and Methods A retrospective analysis of all children with MCDK diagnosed from 2004 until 2012 was performed. The study included 63 patients for whom all postnatal imaging modalities were available: renal bladder ultrasound (RBUS), dimercaptosuccinic acid scan (DMSA) and voiding cystourethrogram (VCUG). Cases with major congenital abnormalities or incomplete data were excluded. Abnormalities in the contralateral kidney and the fate of MCDK were also addressed. Results At diagnosis, the average age was four-and-a-half months. The majority of cases were detected antenatally (87%). Postnatal RBUS and DMSA scans established the diagnosis of MCDK in 92% and 98% of patients, respectively. DMSA showed photopenic areas in the contralateral kidneys in 10% of patients; all of them had hydronephrosis and were confirmed to have vesicoureteral reflux (VUR). Contralateral VUR was detected in 16 patients; 63% of them had hydronephrosis. After a mean follow-up of three-and-a-half years, involution occurred in 62% of patients and the involution rate was inversely proportional to the initial size. Conclusions The classical appearance of MCDK on RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered.Journal of pediatric urology 08/2014; 10(4). DOI:10.1016/j.jpurol.2014.03.004 · 1.41 Impact Factor
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ABSTRACT: Conventional supermarket refrigeration systems are responsible for considerable CO2 emissions due to high energy consumption and large quantities of refrigerant leakage. In the effort to conserve energy and reduce environmental impacts, an efficient design tool for the analysis, evaluation and comparison of the performance of alternative system designs and controls is required. This paper provides a description of the modelling procedure employed in the supermarket simulation model ‘SuperSim’ for the simulation of the performance of centralised vapour compression refrigeration systems and their interaction with the building envelope and HVAC systems. The model which has been validated against data from a supermarket has been used for the comparison of R404A and CO2 refrigeration systems and the optimisation of the performance of transcritical CO2 systems. These results are presented in Part II of the paper.International Journal of Refrigeration 03/2011; 34(2-34):527-539. DOI:10.1016/j.ijrefrig.2010.11.010 · 1.70 Impact Factor