title: Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary?
abstract: BACKGROUND
  Traditionally, a voiding cystourethrogram (VCUG) has been obtained in patients diagnosed with multicystic dysplastic kidney (MCDK) because of published vesicoureteral reflux (VUR) rates between 10%-20%. However, with the diagnosis and treatment of low grade VUR undergoing significant changes, we questioned the utility of obtaining a VCUG in healthy patients with a MCDK. We reviewed our experience to see how many of the patients with documented VUR required surgical intervention.
  
  
  METHODS
  We performed a retrospective review of children diagnosed with unilateral MCDK from 2002 to 2012 who also underwent a VCUG.
  
  
  RESULTS
  A total of 133 patients met our inclusion criteria. VUR was identified in 23 (17.3%) children. Four patients underwent ureteral reimplant (3.0%). Indications for surgical therapy included breakthrough urinary tract infections (2 patients), evidence of dysplasia/scarring (1 patient) and non-resolving reflux (1 patient). All patients with a history of VUR who are toilet trained, regardless of the grade or treatment, are currently being followed off antibiotic prophylaxis. To date, none have had a febrile urinary tract infection (UTI) since cessation of prophylactic antibiotics. Hydronephrosis in the contralateral kidney was not predictive of VUR (p = 0.99).
  
  
  CONCLUSIONS
  Routine VCUG in healthy children diagnosed with unilateral MCDK may not be warranted given the low incidence of clinically significant VUR. If a more conservative strategy is preferred, routine VCUG may be withheld in those children without normal kidney hydronephrosis and considered in patients with normal kidney hydronephrosis. If a VCUG is not performed the family should be instructed in signs and symptoms of urinary tract infection.
authors.affiliation: Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Calaway
authors.forename: Benjamin
authors.initials: B
authors.lastname: Whittam
authors.forename: Konrad M
authors.initials: KM
authors.lastname: Szymanski
authors.forename: Rosalia
authors.initials: R
authors.lastname: Misseri
authors.forename: Martin
authors.initials: M
authors.lastname: Kaefer
authors.forename: Richard C
authors.initials: RC
authors.lastname: Rink
authors.forename: Boaz
authors.initials: B
authors.lastname: Karymazn
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cain
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents