Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment.
OBJECTIVE
To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment.


METHODS
A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney.


RESULTS
Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years.


CONCLUSIONS
In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings.
Cirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: hellencarazo@gmail.com.
M E
ME
Carazo-Palacios
Cirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
M
M
Couselo-Jerez
Urología Infantil, Hospital Universitario y Politécnico La Fe, Valencia, España.
A
A
Serrano-Durbá
Cirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
B
B
Pemartín-Comella
Radiología Infantil, Hospital Universitario y Politécnico La Fe, Valencia, España.
C
C
Sangüesa-Nebot
Urología Infantil, Hospital Universitario y Politécnico La Fe, Valencia, España.
F
F
Estornell-Moragues
Urología Infantil, Hospital Universitario y Politécnico La Fe, Valencia, España.
C
C
Domínguez-Hinarejos
D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000000981:diagnostic imaging*; D020380:Needs Assessment; D011877:Radionuclide Imaging; D012189:Retrospective Studies
Gammagrafía renal; Multicystic kidney; Nefroblastoma; Nephroblastoma; Renal scintigraphy; Riñón multiquístico