Abstract
Neuropathic bladder is considered a threat to the kidneys if not managed appropriately. In this study, we report our experience with neuropathic bladder at King Abdulaziz University Hospital (KAUH) as a cause of chronic renal failure (CRF) in the pediatric age group. This retrospective study included all children diagnosed with neuropathic bladder who presented with moderate or severe CRF over a 4-year period from December 2000 to December 2004 [glomerular filtration rate (GFR) at presentation <50 ml/min per 1.73 m2]. Fifteen patients were diagnosed with neuropathic bladder; group A consisted of ten patients with spina bifida and one with sacral agenesis and group B consisted of four patients with nonneurogenic neurogenic bladders (NNNB). The mean age±SD at presentation was 6.2±3.8 years, GFR was 24.2±12.4 ml/min per 1.73 m2, and creatinine was 289.9±253.2 μmol/l. There were no differences in the age at presentation to a pediatric nephrologist or the degree of renal failure at presentation between the two groups. Clean intermittent catheterization (CIC) was not started in all patients before presentation to KAUH, except in two children. Five children required dialysis as they were in end-stage renal failure (ESRF). All except one received peritoneal dialysis (PD). Their mean age at the start of dialysis was 10.8±1.7 years. Neuropathic bladder due to spina bifida or NNNB is an important cause of CRF in developing countries. There was a considerable delay in the diagnosis of NNNB and a significant delay in starting CIC in all neuropathic patients.
Similar content being viewed by others
References
Brown S, Marshall D, Patterson D, Cunningham AM (1999) Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 9(Suppl 1):29–30
Muller T, Arbeiter K, Aufricht C (2002) Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation. Curr Opin Urol 12:479–484
Schumacher S, Haferkamp A, Muller SC (2003) Bladder dysfunction due to rare neurological disorders. Urologe A 42:1564–1568
Borzyskowski M (2003) Neuropathic bladder: identification, investigation, and management. In: Webb N, Postlethwaite R (eds) Clinical paediatric nephrology. Oxford University Press, New York, pp 179–195
Hinman F Jr (1986) Nonneurogenic neurogenic bladder (the Hinman syndrome)—15 years later. J Urol 136:769–777
Kaneti J, Sober I, Gradus D (1988) Fate of nonneurogenic neurogenic bladder—end-stage renal failure. Eur Urol 14:422–425
Wraige E, Borzyskowski M (2002) Investigation of daytime wetting: when is spinal cord imaging indicated? Arch Dis Child 87:151–155
Johnston LB, Borzyskowski M (1998) Bladder dysfunction and neurological disability at presentation in closed spina bifida. Arch Dis Child 79:33–38
Borzyskowski M, Mundy AR (1988) The management of the neuropathic bladder in childhood. Pediatr Nephrol 2:56–66
Borzyskowski M, Mundy AR, Neville BG, Park L, Kinder CH, Joyce MR, Chantler C, Haycock GB (1982) Neuropathic vesicourethral dysfunction in children. A trial comparing clean intermittent catheterisation with manual expression combined with drug treatment. Br J Urol 54:641–644
Edwards M, Borzyskowski M, Cox A, Badcock J (2004) Neuropathic bladder and intermittent catheterization: social and psychological impact on children and adolescents. Dev Med Child Neurol 46:168–177
Borzyskowski M, Cox A, Edwards M, Owen A (2004) Neuropathic bladder and intermittent catheterization: social and psychological impact on families. Dev Med Child Neurol 46:160–167
Asindi A, Az-Shehri A (2001) Neural tube defects in the Asir region of Saudi Arabia. Ann Saudi Med 21:26–29
Murshid WR (2000) Spina bifida in Saudi Arabia: is consanguinity among the parents a risk factor? Pediatr Neurosurg 32:10–12
Hamed RM (2002) The spectrum of chronic renal failure among Jordanian children. J Nephrol 15:130–135
Koff SA (1992) Relationship between dysfunctional voiding and reflux. J Urol 148:1703–1705
Jayanthi VR, Khoury AE, McLorie GA, Agarwal SK (1997) The nonneurogenic neurogenic bladder of early infancy. J Urol 158:1281–1285
Handel LN, Barqawi A, Checa G, Furness PD III, Koyle MA (2003) Males with Down’s syndrome and nonneurogenic neurogenic bladder. J Urol 169:646–649
Kazee MR, Jackson EC, Jenkins RD (1990) Management of a child on CAPD with a ventriculoperitoneal shunt. Adv Perit Dial 6:281–282
Grunberg J, Rebori A, Verocay MC (2003) Peritoneal dialysis in children with spina bifida and ventriculoperitoneal shunt: one center’s experience and review of the literature. Perit Dial Int 23:481–486
Power RE, O’Malley KJ, Little DM, Donovan MG, Creagh TA, Murphy DM, Hickey DP (2002) Long-term followup of cadaveric renal transplantation in patients with spina bifida. J Urol 167:477–479
Hamdi M, Mohan P, Little DM, Hickey DP (2004) Successful renal transplantation in children with spina bifida: long term single center experience. Pediatr Transplant 8:167–170
Mendizabal S, Estornell F, Zamora I, Sabater A, Ibarra FG, Simon J (2005) Renal transplantation in children with severe bladder dysfunction. J Urol 173:226–229
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kari, J.A. Neuropathic bladder as a cause of chronic renal failure in children in developing countries. Pediatr Nephrol 21, 517–520 (2006). https://doi.org/10.1007/s00467-006-0034-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-006-0034-5