NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Prenatally Diagnosed Solitary Kidneys: is Serial Evaluation with Repeated Ultrasounds Required?
Paul A. Merguerian, MD, FAAP.
Dartmouth-Hitchcock Medical Center, Lebanon, NH,

Background: Infants with prenatally diagnosed solitary kidneys are commonly referred to pediatric urologists for evaluation. The current recommendations are to perform a voiding cystourethrogram (VCUG) and serial renal ultrasounds. There currently are no guidelines as to the number of serial ultrasounds required. We evaluated our database of prenatally diagnosed solitary kidneys to determine the need for performing a VCUG and repeated renal ultrasounds.
Materials And Methods: A retrospective chart review approved by our Institutional Review Board was conducted on all patients seen during the neonatal period with the diagnosis of solitary kidney. Inclusion criteria included all infants under the age of 1 year, and those with a follow up period of at least 2 years. We evaluated the VCUG results and the renal ultrasound studies performed on these children
Results: A total of 46 children with solitary kidneys were identified. Of these 12(26%) were female. A solitary right kidney was found in 28 (61%) and solitary left kidney in 18(39%) . VCUG was performed in 28/46 (61%). Vesicouereteral reflux was discovered in 8(28%). Two were grade I, 6 were grade II and 1 was grade III. Vesicoureteral reflux resolved spontaneously in 7/8 patients. Serial ultrasounds were performed on all patients. Compensatory hypertrophy of the solitary kidney was seen in 45/46(98%) children. A male child with grade III vesicoureteral reflux and no evidence of compensatory hypertrophy developed end stage renal disease.
Conclusion: One third of patients with solitary kidneys will also be found to have vesicoureteral reflux. All children with compensatory hypertrophy on renal ultrasound had normal renal function. Based on these findings we recommend a VCUG on all infants diagnosed with a solitary kidney. We also recommend a renal ultrasound at birth and at 1 year of age. If compensatory hypertrophy is documented, no further follow up is required.


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