Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes. Methods The medical records of 56 children managed from 1997 were available. Socio-demographic and clinical data for SB children managed for a minimum of 2 years (n = 45) were reviewed. This included age at referral, gender, ethnicity, duration of care, type of SB lesion, presence of vesico-ureteric reflux (VUR), symptomatic urinary tract infections, bladder trabeculation, catheterisations and renal function. Results Forty-nine per cent of SB lesions were open myelomeningocoele, 40% were closed lesions and 11% were occult. Majority (96%) were at lumbar L3 or below. Twenty-nine children (64.5%) were referred before 6 months of age (mean15.8 months; range newborn to 125 months). Thirty-five (77.8%) had neurogenic bladder and 31(69%) had neurogenic bowel. Sixteen developed renal scarring and six, CKD. Late referral (≥6 months of age), small kidneys at referral, dilating VUR and bladder trabeculation were significant independent factors associated with scarring. On multivariate analysis, late referral (odds ratio (OR) 17.4; 95% confidence interval (CI) 1.26-238.7) and dilating VUR (OR 137.0; CI 6.4-2921.1) remained significant. Conclusion Prevention of renal scarring and CKD remains a challenge in Malaysia even with multidisciplinary proactive care of SB children. Early referrals and more stringent management strategies for dilating VUR are still required.

Original languageEnglish
Pages (from-to)1175-1181
Number of pages7
JournalJournal of Paediatrics and Child Health
Volume51
Issue number12
DOIs
Publication statusPublished - 1 Dec 2015

Fingerprint

Spinal Dysraphism
Chronic Renal Insufficiency
Cicatrix
Referral and Consultation
Kidney
Neurogenic Urinary Bladder
Malaysia
Neurogenic Bowel
Urinary Bladder
Odds Ratio
Confidence Intervals
Urinary Tract Infections
Catheterization
Medical Records
Multivariate Analysis
Demography
Newborn Infant

Keywords

  • chronic kidney disease
  • dilating VUR
  • neurogenic bladder
  • renal scarring
  • spina bifida

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

@article{c2e5f38a2cb64e7eb8a8416b587e3964,
title = "Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre",
abstract = "Aims The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes. Methods The medical records of 56 children managed from 1997 were available. Socio-demographic and clinical data for SB children managed for a minimum of 2 years (n = 45) were reviewed. This included age at referral, gender, ethnicity, duration of care, type of SB lesion, presence of vesico-ureteric reflux (VUR), symptomatic urinary tract infections, bladder trabeculation, catheterisations and renal function. Results Forty-nine per cent of SB lesions were open myelomeningocoele, 40{\%} were closed lesions and 11{\%} were occult. Majority (96{\%}) were at lumbar L3 or below. Twenty-nine children (64.5{\%}) were referred before 6 months of age (mean15.8 months; range newborn to 125 months). Thirty-five (77.8{\%}) had neurogenic bladder and 31(69{\%}) had neurogenic bowel. Sixteen developed renal scarring and six, CKD. Late referral (≥6 months of age), small kidneys at referral, dilating VUR and bladder trabeculation were significant independent factors associated with scarring. On multivariate analysis, late referral (odds ratio (OR) 17.4; 95{\%} confidence interval (CI) 1.26-238.7) and dilating VUR (OR 137.0; CI 6.4-2921.1) remained significant. Conclusion Prevention of renal scarring and CKD remains a challenge in Malaysia even with multidisciplinary proactive care of SB children. Early referrals and more stringent management strategies for dilating VUR are still required.",
keywords = "chronic kidney disease, dilating VUR, neurogenic bladder, renal scarring, spina bifida",
author = "{P. Yoganathan}, Kanaheswari and {Abdul Manaf}, {Mohd Rizal}",
year = "2015",
month = "12",
day = "1",
doi = "10.1111/jpc.12938",
language = "English",
volume = "51",
pages = "1175--1181",
journal = "Journal of Paediatrics and Child Health",
issn = "1034-4810",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre

AU - P. Yoganathan, Kanaheswari

AU - Abdul Manaf, Mohd Rizal

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Aims The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes. Methods The medical records of 56 children managed from 1997 were available. Socio-demographic and clinical data for SB children managed for a minimum of 2 years (n = 45) were reviewed. This included age at referral, gender, ethnicity, duration of care, type of SB lesion, presence of vesico-ureteric reflux (VUR), symptomatic urinary tract infections, bladder trabeculation, catheterisations and renal function. Results Forty-nine per cent of SB lesions were open myelomeningocoele, 40% were closed lesions and 11% were occult. Majority (96%) were at lumbar L3 or below. Twenty-nine children (64.5%) were referred before 6 months of age (mean15.8 months; range newborn to 125 months). Thirty-five (77.8%) had neurogenic bladder and 31(69%) had neurogenic bowel. Sixteen developed renal scarring and six, CKD. Late referral (≥6 months of age), small kidneys at referral, dilating VUR and bladder trabeculation were significant independent factors associated with scarring. On multivariate analysis, late referral (odds ratio (OR) 17.4; 95% confidence interval (CI) 1.26-238.7) and dilating VUR (OR 137.0; CI 6.4-2921.1) remained significant. Conclusion Prevention of renal scarring and CKD remains a challenge in Malaysia even with multidisciplinary proactive care of SB children. Early referrals and more stringent management strategies for dilating VUR are still required.

AB - Aims The aim of this study was to determine the occurrence of renal cortical scarring and chronic kidney disease (CKD) in children with neurogenic bladder secondary to spina bifida (SB) managed at the Universiti Kebangsaan Malaysia Medical Centre. The secondary objective was to identify the clinical factors associated with these adverse outcomes. Methods The medical records of 56 children managed from 1997 were available. Socio-demographic and clinical data for SB children managed for a minimum of 2 years (n = 45) were reviewed. This included age at referral, gender, ethnicity, duration of care, type of SB lesion, presence of vesico-ureteric reflux (VUR), symptomatic urinary tract infections, bladder trabeculation, catheterisations and renal function. Results Forty-nine per cent of SB lesions were open myelomeningocoele, 40% were closed lesions and 11% were occult. Majority (96%) were at lumbar L3 or below. Twenty-nine children (64.5%) were referred before 6 months of age (mean15.8 months; range newborn to 125 months). Thirty-five (77.8%) had neurogenic bladder and 31(69%) had neurogenic bowel. Sixteen developed renal scarring and six, CKD. Late referral (≥6 months of age), small kidneys at referral, dilating VUR and bladder trabeculation were significant independent factors associated with scarring. On multivariate analysis, late referral (odds ratio (OR) 17.4; 95% confidence interval (CI) 1.26-238.7) and dilating VUR (OR 137.0; CI 6.4-2921.1) remained significant. Conclusion Prevention of renal scarring and CKD remains a challenge in Malaysia even with multidisciplinary proactive care of SB children. Early referrals and more stringent management strategies for dilating VUR are still required.

KW - chronic kidney disease

KW - dilating VUR

KW - neurogenic bladder

KW - renal scarring

KW - spina bifida

UR - http://www.scopus.com/inward/record.url?scp=84983196959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983196959&partnerID=8YFLogxK

U2 - 10.1111/jpc.12938

DO - 10.1111/jpc.12938

M3 - Article

VL - 51

SP - 1175

EP - 1181

JO - Journal of Paediatrics and Child Health

JF - Journal of Paediatrics and Child Health

SN - 1034-4810

IS - 12

ER -