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Journal of the Korean Society of Pediatric Nephrology 2006;10(1): 27-32.
다낭성 이형성 신 환아 46명의 예후와 관련한 임상적 고찰
정일천, 황유식, 안선영, 한상원, 이재승
1연세대학교 의과대학 소아과학교실, 신장질환 연구소
2연세대학교 의과대학 소아과학교실, 신장질환 연구소
3연세대학교 의과대학 소아과학교실, 신장질환 연구소
4연세대학교 의과대학 비뇨기과학교실
5연세대학교 의과대학 소아과학교실, 신장질환 연구소
Clinical Outcome of Multicystic Dysplastic Kidney in 46 Children
Il-Cheon Jeong, You-Sik Hwang, Sun-Young Ahn, Sang-Won Han, Jae-Seung Lee
1Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
2Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
3Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
4Department of Urology, Yonsei University College of Medicine
5Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine
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ABSTRACT
Purpose : Conservative management of multicystic dysplastic kidney(MCDK) without nephrectomy has recently been advocated. The purpose of this study was to determine the clinical course of conservatively managed MCDK and to find out possible predictive factors for involution of MCDK by ultrasonography(US).
Methods : A retrospective analysis was made on 45 patients(26 boys and 20 girls) in whom MCDK was detected and had been traced by US between Dec. 1993 and Aug. 2005 at Severance Hospital.
Results : Median follow-up time was 30 months(range 2-102 months). All patients under-went radionuclide scans and voiding eystourethrograms. The serial follow-up US showed complete involution in 11(24%), partial involution in 19(41%), and no interval change or increased in cyst size in 13(28%) patients. Nephrectomy was done in 3 patients(7%) due to relapsing urinary tract infection(UTI) and severe abdominal distension. The mean age of complete involution of MCDK was 37 months(range 12-84 months). Episodes of UTI were present in 17 patients(37%) and additional genitourinary(GU) abnormalities were found in 22 patients(44%). Hypertension and renal insufficiency was complicated in one patient. No child developed malignant tumor. Univariate analysis showed that five variables were associated with complete involution of the MCDK; gender, site, UTI episode, additional GU abnormalities, and renal length on initial US. After adjusting using the Pearson model, the presence of additional GU abnormalities was exclusively associated with complete involution among the 5 variables(P=0.034).
Conclusion : In our review of 46 cases of MCDK, non-surgical approach for patients with MCDK was advisable and we could predict poor prognosis when MCDK is associated with other GU anomalies.
Key words: Multicystic dysplastic kidney | Conservative management | Involution | Ultrasonography | Poor prognosis
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