Abstract
Objective
Voiding cystourethrogram (VCUG) and radionuclide scan is recommended for patients with solitary (secondary to aplasia or multicystic dysplasia), hypoplasic or single ectopic kidney, to detect associated anomalies (vesicoureteric reflux, obstructive uropathies). With the increase of occasional diagnosis, mainly by fetal ultrasound (US), the possibility of an unjustified extension of diagnostic work up must be prevented. Aim of this paper was to estimate the incidence of associated anomalies in asymptomatic cases without associated US signs of hydronephrosis.
Materials and methods
Among 158 Patients examined there were 81 solitary kidneys (26 multicystic dysplasia), 27 small kidneys, 50 single ectopic kidneys); prenatal diagnosis was recorded in 86%. Incidence of associated anomalies was compared with figures resulting when symptomatic cases or with hydronephrosis were excluded.
Results
Vesicoureteral reflux or obstruction were found in 17% of solitary kidneys, 70% of hypoplasic kidneys and 2% of single ectopic kidneys. Among those (120 cases) without infection or hydronephrosis, incidence decreased, respectively to 5, 60 and 0%.
Conclusions
Associated anomalies are reported to affect up to 48% of solitary kidneys and about 30% of single ectopic; 80% of severe reflux are usually associated to small kidneys. In our series of solitary and ectopic kidneys incidence of abnormalities was significantly less and fell to negligible values when occasionally detected, undilated cases were considered. On this basis, indiscriminate urological screening simply based on the occasional pre or postnatal detection of undilated solitary or ectopic kidney appears to be unjustified. Small kidneys deserve special attention and VCUG is always indicated.
Similar content being viewed by others
References
Hiraoka M, Hirokazu T, Yuusei O, Kenkou K, Yoshinori I, Mitsufumi M (2002) Renal aplasia is the predominat cause of congenital solitary kidney. Kidney Int 61:1840–1844
Cascio S, Paran S, Puri P (1999) Associated urological anomalies in children with unilateral renal agenesis. J Urol 162:1081–1083
Kaneyama K, Yamakata A, Satake S, Yanai T, Lane GL, Kaneko K, Yamashiro Y, Miyano T (2004) Associated urologic anomalies in children with solitary kidney. J Pediatr Surg 39:85–87
Polito C, La Manna A, Rambaldi Pf, Nappi B, Mansi L, Di Toro R (2000) High incidence of a generally small kidney and primary vesicoureteral reflux. J Urol 164:479–482
Guarino N, Tadini B, Camardi P, Silvestro L, Lace R, Bianchi M (2004) The incidence of associated urological abnormalities in children with renal ectopia. J Urol 172:1757–1759
Kramer SA, Kelalis PP (1984) Ureteropelvic junction obstruction in children with renal ectopy. J Urol 90:331–333
Song JT, Ritchey ML, Zerin JM et al (1995) Incidence of vesicoureteric reflux in children with unilateral renal agenesis. J Urol 153:1249–1251
Lebowitz RL, Olbing H, Prkkulainen KV (1985) International system of radiographic grading of vesicoureteral reflux: international reflux study in children. Pediatr Radiol 15:105–109
Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480
Hiraoka M, Hori C, Tsukahara H et al (2002) Congenital small kidney with reflux as a common cause of nephropathy in boys. Kidney Int 52:811–816
Kuwertz-Broeking E, Brinkmann OA, Von Lengerke HJ, Sciuk J, Fruend S, Bulla M, Harms E, Hertle L (2004) Unilateral multicystic displastic kidney: experience in children. Br J Urol 93:388–392
Gleason PE, Kelalis PP, Husman DA, Kramer SA (1994) Hydronephrosis in renal ectopia: incidence, etiology and significance. J Urol 151:1660–1664
Guarino N, Tadini B, Camardi P, Silvestro L, Lace R, Bianchi M (2004) The incidence of associated urological abnormalities in children with renal ectopia. J Urol 172:1757–1759
Yeung CK, Godley ML, Dhillon HK (1997) The characteristic of primary vesicoureteric reflux in male and female infants with prenatal hydronephrosis. Br J Urol 80:319–323
Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Calisti, A., Perrotta, M.L., Oriolo, L. et al. The risk of associated urological abnormalities in children with pre and postnatal occasional diagnosis of solitary, small or ectopic kidney: is a complete urological screening always necessary?. World J Urol 26, 281–284 (2008). https://doi.org/10.1007/s00345-008-0249-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-008-0249-0