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Incidence And Grading Of Vesicoureteral Relfux In Children With Multicystic Dysplastic Kidney: A Meta-Analysis
Florian Friedmacher, MD, Prem Puri, MS, FACS, FAAP.
National Children's Research Centre, Dublin, Ireland.
BACKGROUND: Multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities with a reported incidence of 1 in 4,300 live births. Vesicoureteral reflux (VUR) into the contralateral kidney of children with MCDK is a serious complication and may lead to permanent renal damage in the solitary functioning organ. However, the risk and severity of VUR associated with MCDK is still unknown. The objective of our study was to determine the incidence of VUR in cohorts with MCDK based on a meta-analysis of the published literature.
METHODS: A systematic literature-based search for relevant articles was conducted using MEDLINE (1950-2013), EMBASE (1966-2013) and ISI Web of Science (1899-2013) databases. Search terms were “multicystic dysplastic kidney” AND “vesicoureteral reflux”. Articles not reporting VUR grading based on the results of a voiding cystourethrogram were excluded. The probability of VUR associated with MCDK was calculated using standardized meta-analysis methodology.
RESULTS: Eighty-seven articles met defined inclusion criteria, reporting a total of 5,019 children with MCDK. The MCDK was in 52.41% (95% CI 50.89-53.93) left- and in 47.59% (95% CI 46.07-49.11) right-sided. The overall incidence of VUR associated with MCDK was 18.69% (95% CI 17.45-19.99). VUR was in 85.04% (95% CI 82.15-87.53) contralateral of the MCDK, in 9.78% (95% CI 7.76-12.25) ipsilateral and in 5.19% (95% CI 3.76-7.13) bilateral. Contralateral VUR was classified as grade I in 18.75% (95% CI 14.18-24.37), II in 38.39 % (95% 32.27-44.90), III in 25.45% (95% CI 20.19-31.53), IV in 11.61% (CI 8.05-16.47) and V in 5.80% (95% CI 3.42-9.67). An upper tract dilatation was found in 70.65% (95% CI 64.01-76.51) of all MCDK cases with intermediate or high-grade VUR.
CONCLUSIONS: Our data provide strong evidence that VUR affects approximately 20% of all children with MCDK, with half of them having intermediate or high-grade VUR. Thus, it is important to diagnose and treat VUR early in these children in order to prevent urinary tract infections and associated renal damage.
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