Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
University of Miami Miller School of Medicine, Miami, FL.
Urology. 2020 May;139:156-160. doi: 10.1016/j.urology.2020.02.005. Epub 2020 Feb 18.
To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having vesicoureteral reflux (VUR) or urinary tract infection (UTI) based on the US results.
A retrospective chart review including children with unilateral MCDK with postnatal US and VCUG available at our institution between January 2008 and September 2017 was performed. Analysis was done to find association between abnormal contralateral US and contralateral VUR and UTI.
One hundred and fifty-six children were analyzed; 118(75.6%) patients had a normal contralateral kidney US, while 38(24.4%) had abnormal US. The rate of severe contralateral VUR (grade IV and V) was 2 (1.7%) and 5 (13.2%) in children with normal and abnormal contralateral US, respectively. The risk analysis demonstrated a significant association between severe VUR on the contralateral kidney and an abnormal contralateral US (odds ratio = 7.73; 95%CI: 1.43-41.81; P = 0.018) and no significant association with UTI (odds ratio = 1.58; 95%CI: 0.50-4.94; P = 0.435).
Our data suggests, the rate of severe contralateral VUR in children with unilateral MCDK and normal contralateral kidney is low. VCUG should be considered for infants with proven MCKD and alterations on the contralateral kidney on US. Following patients with MCDK and normal contralateral kidney without the use of VCUG is a reasonable approach, unless there is development of signs and symptoms of recurrent UTI or deterioration of the renal function. We found that abnormal contralateral kidney US was associated with severe VUR.
评估在患有多囊性发育不良肾（MCDK）的儿童中，正常对侧肾脏和膀胱超声（US）与异常对侧肾脏和膀胱 US 的情况下，排尿膀胱尿道造影（VCUG）的价值，并根据 US 结果评估发生输尿管反流（VUR）或尿路感染（UTI）的风险。
对 2008 年 1 月至 2017 年 9 月期间在本机构接受产后 US 和 VCUG 检查的单侧 MCDK 儿童进行了回顾性图表审查。分析了异常对侧 US 与对侧 VUR 和 UTI 之间的相关性。
共分析了 156 名儿童；118 名（75.6%）患者对侧肾脏 US 正常，38 名（24.4%）患者对侧 US 异常。正常对侧 US 的严重对侧 VUR（IV 级和 V 级）发生率分别为 2（1.7%）和 5（13.2%）。风险分析显示，严重对侧 VUR 与异常对侧 US 之间存在显著相关性（优势比=7.73；95%CI：1.43-41.81；P=0.018），与 UTI 无显著相关性（优势比=1.58；95%CI：0.50-4.94；P=0.435）。
我们的数据表明，单侧 MCDK 儿童中对侧正常肾脏的严重 VUR 发生率较低。对于患有明确 MCKD 且对侧肾脏 US 异常的婴儿，应考虑进行 VCUG。对于 MCDK 且对侧肾脏无 VCUG 且无复发性 UTI 或肾功能恶化迹象和症状的患者，采用不使用 VCUG 的方法是合理的。我们发现异常对侧肾脏 US 与严重的 VUR 相关。
