Multicystic dysplastic kidney

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Multicystic dysplastic kidney
Other namesMulticystic renal dysplasia [1]
Multicystic Dysplastic kidney (cropped).png
Diagram of multicystic dysplastic kidney
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg
CausesDue to atresia at 10 weeks gestation [2]
Diagnostic method Ultrasound [3]
TreatmentNephrectomy, if needed [4]

Multicystic dysplastic kidney (MCDK) is a condition that results from the malformation of the kidney during fetal development. The kidney consists of irregular cysts of varying sizes. Multicystic dysplastic kidney is a common type of renal cystic disease, and it is a cause of an abdominal mass in infants. [5]

Contents

Signs and symptoms

When a diagnosis of multicystic kidney is made in utero by ultrasound, the disease is found to be bilateral in many cases. Those with bilateral disease often have other severe deformities or polysystemic malformation syndromes. [6] In bilateral cases, the newborn has the classic characteristic of Potter's syndrome. [7] [8]

The bilateral condition is incompatible with survival, as the contralateral system frequently is abnormal as well. Contralateral ureteropelvic junction obstruction is found in 3% to 12% of infants with multicystic kidney and contralateral vesicoureteral reflux is seen even more often, in 18% to 43% of infants. Because the high incidence of reflux, voiding cystourethrography usually has been considered advisable in all newborns with a multicystic kidney.[ medical citation needed ]

Cause

The cause of multicystic dysplastic kidney can be attributed to genetics. Renal dysplasia can be a consequence of a genetic syndrome, which in turn may affect the digestive tract, nervous system, or other areas of the urinary tract. If the mother had been taking certain prescription drugs such as those for hypertension, this may be a precipitating factor as well. [9]

Pathophysiology

The mechanism of multicystic dysplastic kidney is a result of an abnormal induction of metanephric mesenchyme. This could be a result of a formation difficulty of the mesonephric duct. Some mutations in genes associated with renal dysplasia (in syndromes) have been determined. The mutations in question occur at EYA1 or SIX1 genes (branchio-oto-renal syndrome). The PAX2 gene is also thought to play a role in MCDK. [4]

The contralateral kidney often undergoes hypertrophy. This is believed to be a compensatory mechanism to the non-functional MCDK. About 90% of patients with an MCDK will have contralateral hypertrophy into adulthood. The impact of contralateral hypertrophy on long-term renal outcomes is unknown. [10]

Diagnosis

Ultrasound Scan -Vesicoureteral reflux Ultrasound Scan ND 0119092150 0939241.png
Ultrasound Scan -Vesicoureteral reflux

MCDK is usually diagnosed by ultrasound examination before birth. Mean age at the time of antenatal diagnosis is about 28 weeks [3] A microscopic analysis of urine in individuals with probable multicystic dysplastic kidney should be done. [4] One meta-analysis demonstrated that unilateral MCDK occurs more frequently in males and the greater percentage of MCDK occur on the left side of the body. [11]

Treatment

MCDK is not treatable. However, the patient is observed periodically for the first few years during which ultrasounds are generally taken to ensure the healthy kidney is functioning properly and that the unhealthy kidney is not causing adverse effects. In severe cases MCDK can lead to neonatal fatality (in bilateral cases), however in unilateral cases the prognosis might be better (it would be dependent on associated anomalies). [12] [13]

Epidemiology

In regard to the epidemiology of multicystic dysplasia kidney, the incidence of MCDK is estimated to be 1 in every 4,000 live births, making it rare in terms of the general population. [9]

Related Research Articles

<span class="mw-page-title-main">Hematuria</span> Medical condition

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

Renal agenesis is a medical condition in which one (unilateral) or both (bilateral) fetal kidneys fail to develop.

Potter sequence is the atypical physical appearance of a baby due to oligohydramnios experienced when in the uterus. It includes clubbed feet, pulmonary hypoplasia and cranial anomalies related to the oligohydramnios. Oligohydramnios is the decrease in amniotic fluid volume sufficient to cause deformations in morphogenesis of the baby.

<span class="mw-page-title-main">Hydronephrosis</span> Medical condition

Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter, and hydronephroureter describes the dilation of the entire upper urinary tract.

Atresia is a condition in which an orifice or passage in the body is closed or absent.

<span class="mw-page-title-main">Dysplasia</span> Abnormal development, at macroscopic or microscopical level

Dysplasia is any of various types of abnormal growth or development of cells or organs, and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopic scale include epithelial dysplasia and fibrous dysplasia of bone. Dysplasias on a mainly macroscopic scale include hip dysplasia, myelodysplastic syndrome, and multicystic dysplastic kidney.

<span class="mw-page-title-main">Fraser syndrome</span> Recessive genetic disorder involving eye and genital abnormalities

Fraser syndrome is an autosomal recessive congenital disorder, identified by several developmental anomalies. Fraser syndrome is named for the geneticist George R. Fraser, who first described the syndrome in 1962.

<span class="mw-page-title-main">Barakat syndrome</span> Disease characterized by hypoparathyroidism, sensorineural deafness and renal disease

Barakat syndrome is a rare disease characterized by hypoparathyroidism, sensorineural deafness and renal disease, and hence also known as HDR syndrome. It is an autosomal dominant condition with incomplete penetrance and variable expressivity that was first described by Amin J. Barakat et al. in 1977.

<span class="mw-page-title-main">Simpson–Golabi–Behmel syndrome</span> Congenital disorder

Simpson–Golabi–Behmel syndrome (SGBS), is a rare inherited congenital disorder that can cause craniofacial, skeletal, vascular, cardiac, and renal abnormalities. There is a high prevalence of cancer associated in those with sgbs which includes wilms tumors, neuroblastoma, tumors of the adrenal gland, liver, lungs and abdominal organs. The syndrome is inherited in an X-linked recessive manner. Females that possess one copy of the mutation are considered to be carriers of the syndrome but may still express varying degrees of the phenotype, suffering mild to severe malady. Males experience a higher likelihood of fetal death.

<span class="mw-page-title-main">Vesicoureteral reflux</span> Medical condition

Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direction from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".

<span class="mw-page-title-main">Cystic kidney disease</span> Medical condition

Cystic kidney disease refers to a wide range of hereditary, developmental, and acquired conditions and with the inclusion of neoplasms with cystic changes, over 40 classifications and subtypes have been identified. Depending on the disease classification, the presentation may be at birth, or much later into adult life. Cystic disease may involve one or both kidneys and may, or may not, occur in the presence of other anomalies. A higher incidence is found in males and prevalence increases with age. Renal cysts have been reported in more than 50% of patients over the age of 50. Typically, cysts grow up to 2.88 mm annually and may cause related pain and/or hemorrhage.

<span class="mw-page-title-main">Posterior urethral valve</span> Medical condition

Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. It is the most common cause of bladder outlet obstruction in male newborns. The disorder varies in degree, with mild cases presenting late due to milder symptoms. More severe cases can have renal and respiratory failure from lung underdevelopment as result of low amniotic fluid volumes, requiring intensive care and close monitoring. It occurs in about one in 8,000 babies.

<span class="mw-page-title-main">Papillorenal syndrome</span> Medical condition

Papillorenal syndrome is an autosomal dominant genetic disorder marked by underdevelopment (hypoplasia) of the kidney and colobomas of the optic nerve.

<span class="mw-page-title-main">Meckel–Gruber syndrome</span> Medical condition

Meckel-Gruber syndrome is a rare, lethal ciliopathic genetic disorder, characterized by renal cystic dysplasia, central nervous system malformations, polydactyly (postaxial), hepatic developmental defects, and pulmonary hypoplasia due to oligohydramnios. Meckel–Gruber syndrome is named for Johann Meckel and Georg Gruber.

<span class="mw-page-title-main">Renal–hepatic–pancreatic dysplasia</span> Medical condition

Renal–hepatic–pancreatic dysplasia is an autosomal recessive congenital disorder characterized by pancreatic fibrosis, renal dysplasia and hepatic dysgenesis. An association with NPHP3 has been described. It was characterized in 1959.

<span class="mw-page-title-main">Ovarian vein syndrome</span> Medical condition

Ovarian vein syndrome is a rare condition in which a dilated ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.

Bladder outlet obstruction occurs when urine is unable to flow from the kidneys through the ureters and out of the bladder through the urethra. Decreased flow of urine leads to swelling of the urinary tract, called hydronephrosis. This process of decreased flow of urine through the urinary tract can begin as early as during intrauterine life and it prevents normal development of fetal kidneys and fetal urine. Low levels of fetal urine leads to low amniotic fluid levels and incomplete lung maturation. Older children and adults can also experience bladder outlet obstruction; however, this process is usually reversible and isn't associated with as many poor outcomes as in infants with congenital bladder outlet obstruction.

Perlman syndrome (PS), also known as nephroblastomatosis-fetal ascites-macrosomia-Wilms tumor syndrome, is a rare overgrowth syndrome caused by autosomal recessive mutations in the DIS3L2 gene. PS is characterized by macrocephaly, neonatal macrosomia, nephromegaly, renal dysplasia, dysmorphic facial features, and increased risk for Wilms' tumor. The syndrome is associated with high neonatal mortality.

<span class="mw-page-title-main">Renal hypoplasia</span> Congenital abnormality of the kidneys

Renal hypoplasia is a congenital abnormality in which one or both of the kidneys are smaller than normal, resulting in a reduced nephron number but with normal morphology.

References

  1. RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Multicystic dysplastic kidney". www.orpha.net. Retrieved 31 July 2019.{{cite web}}: CS1 maint: numeric names: authors list (link)
  2. Doubilet, Peter M.; Benson, Carol B. (2003). Atlas of Ultrasound in Obstetrics and Gynecology: A Multimedia Reference. Lippincott Williams & Wilkins. p. 152. ISBN   9780781736336 . Retrieved 2 January 2018.
  3. 1 2 Chang, Ling-Wei; Chang, Fong-Ming; Chang, Chiung-Hsin; Yu, Chen-Hsiang; Cheng, Yueh-Chin; Chen, Hsi-Yao (2002). "Prenatal diagnosis of fetal multicystic dysplastic kidney with two-dimensional and three-dimensional ultrasound". Ultrasound in Medicine & Biology. 28 (7): 853–858. doi:10.1016/s0301-5629(02)00535-5. PMID   12208325.
  4. 1 2 3 Multicystic Renal Dysplasia at eMedicine
  5. Multicystic Dysplastic Kidney Imaging at eMedicine
  6. Seseke, F. (2003). "Clinical Aspects of Paediatric Urology". Imaging in Paediatric Urology. pp. 1–67. doi:10.1007/978-3-642-55785-9_1. ISBN   978-3-642-62803-0.
  7. Potter Syndrome~treatment at eMedicine
  8. Lager, Donna J.; Abrahams, Neil (2012-11-07). Practical Renal Pathology, A Diagnostic Approach: A Volume in the Pattern Recognition Series. Elsevier Health Sciences. p. 27. ISBN   978-1455737864.
  9. 1 2 "Kidney Dysplasia". www.niddk.nih.gov. Retrieved 2015-11-24.
  10. Gaither, Thomas W.; Patel, Ankur; Patel, Chandni; Chuang, Kai-wen; Cohen, Ronald A.; Baskin, Laurence S. (2018). "Natural History of Contralateral Hypertrophy in Patients with Multicystic Dysplastic Kidneys". Journal of Urology. 199 (1): 280–286. doi:10.1016/j.juro.2017.06.075. PMID   28645868. S2CID   206633374.
  11. Schreuder, M. F.; Westland, R.; Van Wijk, J. A. E. (2009). "Unilateral multicystic dysplastic kidney: A meta-analysis of observational studies on the incidence, associated urinary tract malformations and the contralateral kidney". Nephrology Dialysis Transplantation. 24 (6): 1810–1818. doi:10.1093/ndt/gfn777. PMID   19171687.
  12. Stevenson, Roger E.; Hall, Judith G.; Everman, David B.; Solomon, Benjamin D. (2015-10-16). Human Malformations and Related Anomalies. Oxford University Press. p. 800. ISBN   9780199386048.
  13. Schwartz, M. William (2012-01-01). The 5 Minute Pediatric Consult. Lippincott Williams & Wilkins. p. 439. ISBN   9781451116564.

Further reading