White R, Greenfield S P, Wan J, Feld L
Department of Pediatric Urology, State University of New York at Buffalo School of Medicine, Children's Hospital of Buffalo, 14222, USA.
Urology. 1998 Nov;52(5):874-7. doi: 10.1016/s0090-4295(98)00293-3.
To report on the growth characteristics of the affected and contralateral kidneys in children born with multicystic dysplastic kidneys (MCDKs).
Thirty-three patients were enrolled from 1970 to 1995: 23 were initially managed nonoperatively (mean follow-up 3.39 years), and 10 underwent nephrectomy. Patients underwent radionuclide renal imaging and contrast voiding cystography. Serial ultrasonography was used to obtain measurements of the affected and contralateral kidneys. Blood pressure measurements and serum creatinine levels were available in some patients.
Among the 23 nonoperative patients, the affected MCDK involuted in 4 patients during a mean follow-up of 4.5 years at a rate of 1.02 cm/yr (24% annually); 7 kidneys decreased in size at a mean rate of 0.38 cm/yr (5.8% annually); 6 grew at a mean rate of 1.16 cm/yr (9.9% annually); 1 kidney did not change in size; and 5 children were lost to follow-up. The mean size of the contralateral kidneys at birth was 5.3 cm, 2 standard deviations larger than normal. Over time, this relative hypertrophy was maintained at a growth rate of 0.89 cm/yr (18.5% annually). Two patients who had undergone nephrectomy also had serial postoperative ultrasonic renal measurements, and contralateral growth was 0.61 cm/yr (12.16% annually). All but 1 patient had normal blood pressure measurements and serum creatinine levels.
Most MCDKs involute or decrease in size over time, although this may take many years. Contralateral hypertrophy is seen at birth and is maintained during childhood growth, regardless of whether the affected kidney is removed. There is no associated hypertension or malignancy when the dysplastic kidney is left in place.
报告患有多囊性发育不良肾（MCDK）的儿童患侧及对侧肾脏的生长特征。
1970年至1995年共纳入33例患者：23例最初采用非手术治疗（平均随访3.39年），10例行肾切除术。患者接受放射性核素肾显像及排尿性膀胱尿道造影。采用系列超声检查测量患侧及对侧肾脏。部分患者有血压测量值及血清肌酐水平数据。
在23例非手术治疗的患者中，4例患侧MCDK在平均4.5年的随访期间内萎缩，萎缩速率为每年1.02 cm（每年24%）；7例肾脏体积减小，平均速率为每年0.38 cm（每年5.8%）；6例肾脏体积增大，平均速率为每年1.16 cm（每年9.9%）；1例肾脏大小无变化；5例患儿失访。出生时对侧肾脏的平均大小为5.3 cm，比正常大2个标准差。随着时间推移，这种相对肥大以每年0.89 cm（每年18.5%）的生长速率维持。2例行肾切除术的患者术后也进行了系列超声肾脏测量，对侧肾脏生长速率为每年0.61 cm（每年12.16%）。除1例患者外，所有患者血压测量值及血清肌酐水平均正常。
多数MCDK会随着时间推移而萎缩或体积减小，尽管这可能需要数年时间。出生时即可见对侧肥大，并在儿童生长期间维持，无论患侧肾脏是否切除。保留发育不良的肾脏时，无相关高血压或恶性肿瘤发生。
