Factors Affecting Renal Scar Development in Children with Spina Bifida

Abstract

Background/Aims: Prevention of renal scarring is the main therapeutic goal in children with spina bifida. We aimed to determine factors affecting renal scar development in these patients. Materials and Methods: Records of 312 children admitted between 1994 and 2005 with spina bifida were reviewed. Age on admission, gender, presence of previous febrile urinary tract infections (UTIs), vesicoureteral reflux (VUR), and initial urodynamic findings were noted. Patients were grouped regarding presence/absence of renal scars on DMSA scans. χ² and Student’s t tests were used for statistical evaluation. Results: Seventy-two patients had renal scars on admission. Mean age was 4.62 ± 4.59 years for patients without renal scars and 6.35 ± 4.9 years for patients with scars. Male/female ratio was 1:1 in the scarless group and 1:2 in the group with scars. Previous febrile UTI was present in 11 of 240 scarless patients in contrast to 7 out of 72 patients in the scar group (p > 0.05). VUR was present in only 16.3% of cases without scars, whereas 36.1% of patients in the scar group had VUR. Detrusor overactivity and detrusor sphincter dyssynergia were observed in 67.1% of scarred patients, whereas this figure was 42.4% in the scarless group. The comparison of age on admission, gender, detrusor overactivity, and detrusor sphincter dyssynergia revealed significant differences between patients with and without renal scars. Conclusions: Late referral, female gender, overactive detrusor, and detrusor sphincter dyssynergia have detrimental effects on renal parenchymal function in spina bifida patients. Patient selection for aggressive treatment using these features may prevent renal parenchymal deterioration.

International children's continence society's recommendations for initial diagnostic evaluation and follow‐up in congenital neuropathic bladder and bowel dysfunction in children

“…Since the introduction of proactive management of children with spina bifida,5 there has been a marked reduction in their progression to end‐stage renal disease (ESRD) 6. If left untreated, neonates with detrusor sphincter dyssynergy (DSD) develop upper urinary tract damage in the first year of life, starting shortly after birth and in some cases even during fetal life 2, 5, 7. If untreated, death due to renal failure, in the first year of life, can be as high as 20%.…”

Urinary tract infections in children with spina bifida: an inventory of 41 European centers

“…Antibiotic prophylaxis is one of the many daily medications prescribed for patients with NBSD, although many European centers have already switched to a need-totreat prophylactic regimen, thereby abandoning the ancient adagium that LDCP should be prescribed to every patient on CIC. The main arguments used for persisting in starting or continuing LDCP are VUR, congenital urinary tract anomalies and recurrent UTIs [8,10,24,25]. When VUR has resolved, either spontaneously, due to anticholinergic medication or by surgical correction, and UTIs are under control, most clinicians cease the LDCP, in accordance with protocols reported by several studies on VUR and LDCP in the general pediatric population [10,[14][15][16][17][18].…”

Analysis of the permanent renal injury risk factors in congenital neuropathic bladder

“…Benzer olarak Özel ve ark. (12) yaptığı çalışmada da nörojen mesane tedavisinin geciktiği olgularda böbrek hasar gelişme riskinin arttığını bildirdiler. Dik ve ark.…”