ESPN 50th Annual Meeting

ESPN 2017


 
Risk Factors for Renal Scarring in Children with Myelomeningocele
FATMA LALE SEVER 1 YEŞIM KÜÇÜKKAGNICI 1 NUR CANPOLAT 1 MEHMET ELIÇEVIK 1 SALIM ÇALIŞKAN 1

1- ISTANBUL UNIVERSITY, CERRAHPASA MEDICAL FACULTY, ISTANBUL, TURKEY
 
Introduction:

Most children with myelomeningocele have neurogenic bladder while bladder dysfunction predisposes patients to urinary tract infection (UTI), renal scarring and renal failure. We aimed to evaluate risk factors for renal scarring in these patients. 

Material and methods:

Fifty-three children with neurogenic bladder due to myelomeningocele (28 male; mean presentation age 18±19 months; current age 7.0±3.6 years), followed-up at least one year after urodynamic testing were enrolled in this single center study. Anthropometric indices, spinal lesion levels, shunt status, ambulatory ability, episodes of UTI, ultrasonographic and urodynamic findings, presence of vesicoureteral reflux (VUR), eGFR and serum cystatin-C levels were recorded. Forty-seven patients (89%) had been performing clean intermittent catheterization (CIC). Patients applying at least >75% of CIC suggestions were defined as “compliant”. Low bladder capacity was defined as bladder capacity <65% of expected volume by urodynamic testing. Renal scarring was diagnosed by most recent DMSA scans. 

 

Results:

The mean follow-up period was 66±34 months. Twenty-four patients (45%) had VP shunt. Spinal lesion levels were as follows: lumbosacral region in 28, lumbar in 13, sacral in 7 and thoracolumbar in 5. DMSA scintigraphy revealed renal scarring in 9 (17%) patients, which was not associated with gender, age of CIC initiation or current age, level of spinal lesion, ambulatory disability or none of urodynamic parameters except low bladder capacity. Significant risk factors for renal scarring are shown in Table 1. There was no difference between eGFR values of the patients with or without scarring, whereas serum cystatin C levels were significantly higher in patients with scarring (0.80±0.20 vs 0.63±0.09, p=0.03).

Table I: Significant risk factors for renal scarring  

 

All patients

n=53

Scarring (+)

n=9

Scarring(-)

n=44

P

No. of UTI between 0-2 years

0.9±1.4

3.0±1.9

0.6±1.0

0.007

UTI episodes >3, n (%)

8 (15%)

4 (44%)

4 (9%)

0.008

VUR (+), n (%)

9 (17%)

5 (56%)

4 (9%)

0.001

CIC compliance, n (%)

38 (71%)

4 (44%)

34 (90%)

0.002

Low Bladder Capacity, n (%)

10 (19%)

5 (56%)

5 (11%)

0.007

Conclusions:

CIC compliance and avoidance of UTI may preventrenal scarring in patients with myelomeningocele.