Sukthankar S, Watson A R
Children and Young People's Kidney Unit, City Hospital, Nottingham, UK.
Acta Paediatr. 2000 Jul;89(7):811-3. doi: 10.1080/080352500750043701.
Controversy exists as to what is the optimal management of antenatally detected multicystic dysplastic kidney disease (MCDK): conservative or operative. We report 70 (31M, 39F) children with unilateral MCDK in whom the initial micturating cystourethrography revealed vesicoureteric reflux into the contralateral kidney in 16/63 (25%). Involution of the MCDK kidney was noted at birth in 4 and occurred by 2 y of age in 11/46 (24%), with 16/46 (35%) showing a significant reduction in size. Of 21 children followed to 5 y, the MCDK had disappeared in 3 (14%) and 8 (38%) had shown a further reduction in size. No child has developed hypertension or proteinuria. Four children had urinary tract infections with lower tract symptoms, but no scarring of the normal hypertrophied kidney. We conclude that conservative management of unilateral MCDK is justified with long-term follow-up consisting of annual clinical review and ultrasound evaluation at 2, 5 and 10 y.
对于产前检测出的多囊性发育不良性肾病(MCDK),最佳治疗方法是保守治疗还是手术治疗,目前仍存在争议。我们报告了70例(31例男性,39例女性)单侧MCDK患儿,其中63例最初的排尿性膀胱尿道造影显示16例(25%)存在膀胱输尿管反流至对侧肾脏。4例MCDK肾在出生时即已萎缩,46例中有11例(24%)在2岁时发生萎缩,46例中有16例(35%)肾脏大小显著减小。在随访至5岁的21例儿童中,3例(14%)的MCDK已消失,8例(38%)肾脏大小进一步减小。没有儿童出现高血压或蛋白尿。4例儿童出现下尿路症状的泌尿系统感染,但正常肥大的肾脏未出现瘢痕形成。我们得出结论,单侧MCDK采用保守治疗是合理的,长期随访包括每年进行临床检查以及在2岁、5岁和10岁时进行超声评估。