Indications for nephrectomy in children: What has changed?

Objective: To review the indications for nephrectomy in children between 1990 and 2001, at the Starship Children's Hospital, Auckland, New Zealand. Patients and methods: There were 206 nephrectomies. A retrospective review of the patients' notes was performed. The 12-year period was divided into two halves (1990-1996 and 1996-2001) which were then compared. Results: The total number of nephrectomies per year significantly increased over the period of the study (11.5 and 22.2 per year for 1990-1995 and 1996-2001, respectively; P < 0.05), as did the number of partial nephrectomies (one and 23 for 1990-1995 and 1996-2001, respectively; P < 0.01). Multicystic dysplastic kidney (MCDK), Wilms' tumour and vesico-ureteric reflux (VUR) accounted for more than half of the nephrectomies (60% and 68% for 1990-1995 and 1996-2001, respectively). The proportion of nephrectomies performed for these indications did not change (MCDK 25% and 34%, Wilms' 25% and 18%, VUR 16% and 18%, for 1990-1995 and 1996-2001, respectively), but fewer nephrectomies were performed for pelvi-ureteric junction (PUJ) obstruction in the second half of the study period (13% and 4% for 1990-1995 and 1996-2001, respectively; P < 0.05). Conclusion: The total number of nephrectomies, including partial nephrectomies, has increased significantly. The decrease in nephrectomies for PUJ obstruction could be accounted for by a more aggressive approach in the management and follow up of prenatally diagnosed hydronephrosis. Of note is that there was no significant change in the proportion of nephrectomies performed for Wilms' tumour, MCDK and VUR.