Renal involvement in children with spina bifida.

Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. An early start of therapy helps to safeguard renal function for such children and avoid end-stage renal disease. However, optimal care is not always available in developing countries. We reviewed our data on all newborns with spina bifida who were born at King Abdulaziz University Hospital between 1997 and 2006. Thirty-three children with myelomeningocele (MMC) were evaluated; MMC site was thoracolumbar in 26 patients (77.1%) and in the lumbosacral area in 7 patients (22.9%). The mean age at the time of evaluation was 5.4 +/- 2.3 years. Thirty (90%) patients presented with neurogenic bladder, and 26(78%) with vesico-uretral reflux (VUR). Only 8 patients (group A) received clean intermittent catheterization (CIC), while the rest (group B) were either non-complaint or not on any therapy. Urinary tract infections overall were 4.5 +/- 3.8 per year. Patient undergoing CIC had a lower number of UTI (mean per year) 3.3 +/- 1.2 vs 6.6 +/- 2.3. Sixty two percent of group A had VUR compared with 93% in group B. The mean creatinine was 46 +/- 39 micromol/L for the whole group. However, group A had a lower mean creatinine 38 +/- 11 compared to 50 +/- 34 in group B. In conclusion, early intervention to relieve urinary retention in children born with spina bifida resulted in preserving renal function and less incidence of VUR and UTI. There is a need of more awareness about the importance of starting proactive treatment of risks of upper urinary tract disease and development of renal failure in babies with spina bifida.