چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
|---|---|
| افشین قلعه گلاب بهبهانی | اول |
| عنوان | متن |
|---|---|
| خلاصه مقاله | Introduction This review article is prepared to answer the clinical question about patients with unilateral Multicystic Dysplastic Kidney (MCDK) if they need Voiding Cysto-urethrography (VCUG) as a routine work up. Discussion In one study (2004) included 97 children (60 boys,37 girls) with Unilateral MCDK, the contralateral kidney showed anomalies in 19 of 97 children (20%) by different imaging techniques (Scan, US, IVP &VCUG); 89 children (92%) had VCUG. Sixteen of the 19 anomalies (84%) were detected by US. In only 4 of the 89 children (4.5%), VUR was found by VCUG. The researchers claimed that low rate of reflux makes routine VCUG unnecessary if the contralateral upper urinary tract and kidney appear to be normal on US. In a systematic review and meta-analysis (2019) from 698 retrieved articles, 37 studies enrolling 2057 patients (80% male – 20% female) were analyzed; 50% had left unilateral MCDK; 87% were diagnosed prenatally. A total of 1800 patients had VCUG, of whom 303 had VUR (17%), grades I-II were 58%, grades III-V were 42%. Of the patients, 99% were on continuous antibiotic prophylaxis, 18% had urinary tract infections (UTIs) with a higher rate of UTIs (23% vs 10%) in patients with dilating VUR (grades III-V) vs lower grades, In patients with dilating VUR (grades III-V). Over a mean follow up of 40 months: 23% will develop a UTI on the single functional kidney despite continuous antibiotic prophylaxis; VUR resolved or downgraded to grade I in 52%, and finally, 32% had surgical correction of VUR. The researchers recommended Shared decision-making with the patient’s caregivers, where the risks and benefits of the different approaches can be discussed. Another retrospective study in 2019, including 75 children with unilateral MCDK, (excluding patients with other genetic or chromosome abnormalities, spinal cord diseases, or anal atresia), Abnormal VCUG findings in 24 of 75 patients (32%), VUR in 8 (10.6%), and lower urinary tract or bladder disease in 16 (21.3%). The only abnormal findings by (one to three times) ultrasonography was an independent risk factor for abnormal VCUG findings with statistical significance in multivariate analysis (OR 6.57; 95% CI 1.99-26.26; P = 0.002). Abnormal findings by ultrasonography to predict urologic anomalies by VCUG in these children: Sensitivity=83%, Specificity= 59%, positive predictive value=49%, negative predictive value=88%. Conclusion Among children with unilateral MCDK, Only who has abnormal findings by ultrasonography, should undergo VCUG. It must be emphasized that ultrasonography should be performed repeatedly (1 to 3 times) to detect congenital anomalies of the urinary tract. |
| کلمات کلیدی | VCUG , MCDK |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| Certificate.pdf | 1399/09/25 | 52450 | دانلود |
| Dr A G Behbahan Invitation.docx | 1399/09/28 | 2938156 | دانلود |
| Necessity of Performing VCUG for Children with Unilateral MCDK.docx | 1399/09/28 | 215235 | دانلود |
