Neuropathic bladder as a cause of chronic renal failure in children

ABSTRACT

A retrospective study of all paediatric cases diagnosed as neurogenic bladder and presented with chronic renal failure [CRF] [GFR <50 ml/minute/1.73 m2] from December 2000 to December 2004. Fifteen patients were diagnosed as neuropathic bladder. Group A included nine spina bifida and one sacral agenesis cases and group B included four non-neurogenic neurogenic bladder [NNNB] cases. The mean age +/- SD at presentation was 6.2 +/- 3.8 years, GFR level was 24.2 +/- 12.4 ml/minute/1.73 m2 and creatinine level was 289.9 +/- 253.2 mumol/l. There was no difference in the age of presentation to paediatric nephrologist or the degree of renal failure at presentation between the two groups. All children with NNNB in group B presented with recurrent urinary tract infection [UTI] and the two older children were also reported as wet during the day. Clean intermittent catheterization [CIC] was not started in all patients before presentation to KAUH, except in two children, in whom it was started by urologists. Five children required dialysis, as they were in end stage renal failure [ESRF]; four in group A and one in group B. All cases, except one, received peritoneal dialysis [PD]. Their mean age at the start of dialysis was 10.8 +/- 1.7 years. Two children with shunted hydrocephalus were dialyzed peritoneally; one of them had peritonitis and complicated with a Staph. epidermis shunt infection; therefore this case was shifted to haemodialysis and required externalization of the V-P shunt for few weeks. Only one patient was started on haemodialysis from the start due to social reasons