Is the risk of hypertension an indication for prophylactic nephrectomy in patients with unilateral multicystic dysplastic kidney?
OBJECTIVE
Surgery is still proposed by some as the treatment of choice for unilateral multicystic dysplastic kidney (UMCDK) because of the potential complications of hypertension, infection and malignant change. The purpose of this study is to demonstrate that the risk of hypertension does not justify routine nephrectomy.


METHODS
We report 41 cases of UMCDK, treated between 1980 and 2001, 28 of whom were male (68%). Twenty-one patients were nephrectomized (51%). Twenty patients (49%) underwent clinical and ultrasound follow-up. Blood pressure was controlled every 3-4 months (over a period ranging from 9 months to 6 years) and an ultrasound scan was performed every 6 months during the first 2 years, and annually thereafter.


RESULTS
In the patients treated non-operatively we observed a progressive spontaneous involution of their multicystic dysplastic kidneys and the total absence of complications such as hypertension or malignancy.


CONCLUSIONS
It is reasonable to conservatively manage patients with UMCDK by means of repeated ultrasound examinations and blood pressure control.
Department of Pediatrics-Pediatric Surgery, Univeersity Federico II, Via Pansini 5, 80131 Naples, Italy. stilemis@tiscali.it
S
S
Tilemis
A
A
Savanelli
D
D
Baltogiannis
B
B
Cigliano
A
A
Settimi
D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology*; D007223:Infant; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000150:complications / Q000601:surgery*; D009392:Nephrectomy; D012307:Risk Factors; D016896:Treatment Outcome