ESPN 53rd Annual Meeting

ESPN 2021


 
A national survey of management of unilateral multicystic dysplastic kidney (MCDK) in the United Kingdom
DOUGLAS STEWART 1 MATTHEW HARMER 2 PALLAVI PRASAD 3 FAIDRA VELIGRATLI 1 CHARLES PICKLES 6 JI SOO KIM 4 MADURI RAJA 5

1- EVELINA LONDON CHILDRENS HOSPITAL
2- BRISTOL ROYAL HOSPITAL FOR CHILDREN
3- ALDER HEY CHILDRENS HOSPITAL
4- GREAT ORMOND STREET CHILDRENS HOSPITAL
5- SOUTHAMPTON CHILDRENS HOSPITAL
6- GREAT NORTH CHILDRENS HOSPITAL
 
Abstract:

Objectives: To explore variation in management of unilateral MCDK amongst paediatricians.

 

Methods: A nationwide online survey, with multiple choice and free text questions, was open to tertiary paediatric nephrology and general paediatric consultants between August and December 2020.

 

Results: Of 60 respondents, two-thirds were paediatric nephrologists. 62% routinely perform a DMSA scan to confirm diagnosis (paediatric nephrologists [58%]; specialist interest paediatricians [67%]; non-specialist interest paediatricians [80%]). 8% routinely perform a cystogram to investigate contralateral vesicoureteric reflux. 62% would undertake routine renal function assessment with frequency ranging from once only (62%) to “every two years”. Nephrectomy thresholds quoted were: “still present at 3/4 years”, “still present at 5 years”, “3cm at 5 years”, and “6cm at 6 years”. 25% recalled MCDK nephrectomy within the previous five years. Respondents voiced concerns that national guidance may result in an overcautious approach but could (1) balance between consensus and safe variation, and (2) offer families choice and reassurance. 

 

Estimated costs were calculated from the respondents’ answers. Mean estimated cost from birth to 18 years was £1,962 (range: £258-£3,854). Although the average costs were greater for general paediatricians compared to paediatric nephrologists, this was not statistically significant (£1,950 SD±£871 versus £1,485 SD±£829).

 

Conclusions: Management of unilateral MCDK varies amongst UK paediatricians. Despite consensus for avoiding invasive testing, the risks of hypertension and progression to chronic kidney disease remains. This highlights the need for a clear pathway to decrease unwanted variability to ensure early recognition of those at high-risk of renal sequelae whilst avoiding undue investigatory burden on the patient.