title: Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation.
abstract: ObjectiveSurgery is still indicated as the treatment of choice in subset of patients with unilateral multicystic dysplastic kidney (UMCDK) because of its potential complications and malignant change. The purpose of this study is to present our observation that early nephrectomy may cure hypertension early in children with UMCDK and review the literature.Materials and MethodsWe report here four children (two males and two females) with antenatally diagnosed UMCDK with hypertension, treated in the past 4 years. All have antenatal diagnosis of UMCDK and referred to us after their birth. Diagnosis of hypertension (blood pressure > 95th percentile) was made after 3 months of follow-up in all patients. Nephrectomy was performed in all children in variable time duration. Hypertension, urinary tract infection, and desire of parents were the main indication of surgery.ResultsAll children showed decrease in the size of their dysplastic kidney with time, but hypertension was persistent and needed antihypertensive drugs; even increase in the doses in successive follow-up. After nephrectomy, three children who were operated early got cured having normal blood pressure within variable time duration, while a child, operated late, still had high blood pressure and needed antihypertensive drugs.ConclusionEarly nephrectomy in recently diagnosed hypertension in UMCDK is advisable and can cure hypertension early.Levels of EvidenceThe level of evidence is IV (case series with no comparison group).
authors.affiliation: Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Basant
authors.initials: B
authors.lastname: Kumar
authors.affiliation: Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Vijai Datta
authors.initials: VD
authors.lastname: Upadhyaya
authors.affiliation: Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Laxmi Kant
authors.initials: LK
authors.lastname: Bharti
authors.affiliation: Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Ram Nawal
authors.initials: RN
authors.lastname: Rao
authors.affiliation: Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Sheo
authors.initials: S
authors.lastname: Kumar
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000150:complications / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome