An antenatal scan detected multiple non-communicating cysts replacing the left kidney of a fetus. Postnatal DMSA scan shows no function on the left, and the right kidney is normally sized with good function. Serum creatinine is normal. What is the most appropriate management?
- A Conservative follow-up with serial ultrasounds and blood pressure monitoring ✓
- B Immediate left nephrectomy in infancy
- C Open biopsy of the cystic mass
- D Prophylactic antibiotic suppression until nephrectomy at puberty
Correct answer: A. Conservative follow-up with serial ultrasounds and blood pressure monitoring
Explanation
Multicystic dysplastic kidney is a non-functioning dysplastic kidney with non-communicating cysts, usually managed conservatively when the contralateral kidney is normal, using periodic ultrasound, blood pressure checks and renal function tests. Routine nephrectomy is no longer recommended because these kidneys commonly involute spontaneously, and malignancy risk is very low. Biopsy adds nothing once imaging and a DMSA scan confirm the non-functioning dysplastic unit.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.