Clinical outcome of prenatally diagnosed duplex kidneys

Abstract

Duplex kidneys may be diagnosed in the prenatal period, but the clinical significance of this finding is unclear as many neonates will be asymptomatic. This study aims to assess the clinical outcome for children diagnosed correctly with a duplex kidney in the prenatal period. Liveborn infants with a correct prenatal diagnosis of duplex kidneys between January 1992 and January 2002 were ascertained from the unit's computerised databases. The sonographic features identified prenatally were recorded. Clinical outcome was ascertained from the hospital at which the child was undergoing care. Forty-five infants were identified with follow-up ranging from 1 to 9 years. One infant died in the neonatal period due to co-existent autosomal recessive polycystic kidney disease. Fourteen remain asymptomatic with conservative management. Eleven underwent ureterocoele puncture, eight requiring subsequent heminephrectomy. The remaining 19 underwent heminephrectomy as a first-line procedure. Heminephrectomy was indicated in all cases by either recurrent urinary tract infection despite ureterocoele puncture or antibiotic prophylaxis, or a poorly functioning moiety, and in most cases was carried out before 18 months. If only one diagnostic feature was seen prenatally, equal numbers were managed conservatively as were managed surgically. Where more than one feature was seen, or where a ureterocoele was identified, the majority underwent surgical management.