Page 1 - Multicystic dysplastic kidney (MCDK) in the neonate: The role of the urologist

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guideline

Multicystic dysplastic kidney (MCDK) in the neonate:

The role of the urologist

Karen Psooy, MD, in collaboration with the Pediatric Urologists of Canada (PUC)
1
1 University of Manitoba, Winnipeg, MB, Canada

Cite as: Can Urol Assoc J 2016;10(1-2):18-24. http://dx.doi.org/10.5489/cuaj.3520 and followup for same. Following this literature review,
Published online February 8, 2016. “Renal cell carcinoma and other adult renal malignancies”
and “Anomalies of the internal genitalia” were added to
the list of “Medical conditions perceived or shown to be
Background 1 associated with MCDK.” Levels of evidence and grades of
recommendations are based on the modified Oxford Centre
The urological management of multicystic dysplastic kid- for Evidence‐Based Medicine grading system for guideline
neys (MCDK) in the pediatric population is controversial. recommendations.
Historically, MCDK was rare, presenting with a palpable
mass or symptoms, and was managed with open neph - Literature review
rectomy. Wilms tumor (WT) was listed in the differential
diagnosis. Introduction of antenatal ultrasound (US) trans- This revision includes the findings of the previous literature
formed unilateral MCDK into a common condition (1/4300 review, in addition to the following literature review:
2
live births), which is generally asymptomatic at presen- – Databases: Embase, Pubmed and Papers Conference
tation. Observation through a MCDK registry determined Index, with key word searches:
and reported in 1993 that the low risk of WT developing • “multicystic kidney” and “multicystic dysplastic kid-
in these kidneys did not justify prophylactic nephrectomy ney” paired with “Wilms tumor,” “hypertension,”
and that observation with periodic US was safe, but as of “vesicoureteral reflux,” “natural history,” “nephrec-
2007, a cost-effective protocol had not been established. tomy” (2007–2014)
With widespread adoption of pediatric laparoscopy, there • “multicystic kidney” and “multicystic dysplastic
was potential for the pendulum to swing back to prophylac- kidney” paired with “renal cell carcinoma” and
tic nephrectomy as management for MCDK. However, the “cancer” (no year restriction)
indications cited for intervention were more to relieve the – Database: Pubmed, with key word search:
iatrogenic symptoms caused by long-term observation, those • “multicystic kidney” and “multicystic dysplastic kid-
being parental anxiety and costs to the healthcare system, ney” paired with “genitalia” and “genital anoma-
rather than any confirmed medical indications. lies” (no year restriction)
This CUA Guideline was initially developed in 2008. The titles of all identified articles were reviewed. Abstracts
The recommendations were based on a literature review were read if titles were pertinent. Abstracts of articles related
carried out in 2007 to determine whether perceived med- to pertinent articles were reviewed. English articles were
ical concerns regarding MCDK could be substantiated and read if pertinent to the questions to be addressed in the
to determine what degree of urological investigation and update. Relevant articles referenced in the read articles were
observation was actually necessary for the neonate with a reviewed for pertinence.
MCDK. 1
In 2015, this CUA Guideline was updated following 2014 update on management controversies
a 2014 literature review to determine whether manage -
ment controversies continued to exist, to obtain up-to-date Since 2008, a nonsurgical approach remains the initial man-
information regarding the medical implications of having agement for MCDK. The main controversy revolves around
a MCDK, and to determine the appropriate investigation the appropriate intensity and length of US followup. On

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