Kumar Basant, Upadhyaya Vijai Datta, Gupta Manish Kumar, Bharti Laxmi Kant, Rao Ram Nawal, Kumar Sheo
Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Eur J Pediatr Surg. 2017 Dec;27(6):533-537. doi: 10.1055/s-0037-1599837. Epub 2017 Mar 27.
Surgery is still indicated as the treatment of choice in subset of patients with unilateral multicystic dysplastic kidney (UMCDK) because of its potential complications and malignant change. The purpose of this study is to present our observation that early nephrectomy may cure hypertension early in children with UMCDK and review the literature. We report here four children (two males and two females) with antenatally diagnosed UMCDK with hypertension, treated in the past 4 years. All have antenatal diagnosis of UMCDK and referred to us after their birth. Diagnosis of hypertension (blood pressure > 95th percentile) was made after 3 months of follow-up in all patients. Nephrectomy was performed in all children in variable time duration. Hypertension, urinary tract infection, and desire of parents were the main indication of surgery. All children showed decrease in the size of their dysplastic kidney with time, but hypertension was persistent and needed antihypertensive drugs; even increase in the doses in successive follow-up. After nephrectomy, three children who were operated early got cured having normal blood pressure within variable time duration, while a child, operated late, still had high blood pressure and needed antihypertensive drugs. Early nephrectomy in recently diagnosed hypertension in UMCDK is advisable and can cure hypertension early. The level of evidence is IV (case series with no comparison group).
由于单侧多囊性发育不良肾（UMCDK）存在潜在并发症和恶变风险，手术仍是部分UMCDK患者的首选治疗方法。本研究旨在介绍我们的观察结果，即早期肾切除术可在患有UMCDK的儿童中早期治愈高血压，并对相关文献进行综述。我们在此报告4例在过去4年中接受治疗的产前诊断为UMCDK并伴有高血压的儿童（2男2女）。所有患儿均在产前诊断为UMCDK，出生后转诊至我们处。所有患者在随访3个月后诊断为高血压（血压>第95百分位数）。所有儿童均在不同时间进行了肾切除术。高血压、尿路感染和家长的意愿是手术治疗的主要指征。所有儿童的发育不良肾体积均随时间减小，但高血压持续存在，需要使用降压药物，甚至在后续随访中增加剂量。肾切除术后，3例早期手术的儿童在不同时间段内血压恢复正常，而1例晚期手术的儿童仍有高血压，需要使用降压药物。对于新诊断为高血压的UMCDK患者，早期肾切除术是可取的，并且可以早期治愈高血压。证据级别为IV级（无对照组的病例系列）。
