The association between urodynamic findings and chronic kidney disease in children with neurogenic lower urinary tract dysfunction: A potential model for a standardised risk-based surveillance tool in South Africa
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Abstract
Background: Patients with neurogenic lower urinary tract dysfunction (NLUTD) have an increased risk of chronic kidney disease (CKD). Urodynamic studies (UDS) are used to risk-stratify these patients for renal deterioration. The key study objective was to assess the association of UDS parameters with CKD and use this data to develop a risk-based surveillance tool for monitoring patients with NLUTD.
Methods: A retrospective descriptive study was conducted at two public tertiary hospitals in South Africa (SA). The study included UDS conducted between July 2013 and June 2018 on children younger than 18 years with NLUTD. Simple random sampling followed by screening to select the reports that met the criteria was done. Parameters analysed were: percentage bladder capacity (PBC), end filling pressure, compliance, detrusor activity, detrusor leak point pressure and vesicoureteral reflux (VUR). Glomerular filtration rate (GFR) was used to establish the presence of CKD.
Results: A total of 105 UDS reports of children aged 11 months to 17 years were analysed. CKD was identified in 23% of participants. Female sex and VUR were found to be associated with CKD. There was a significant difference in the mean age and mean PBC between those without and those with CKD (8 years vs 11 years and 82.04% vs 59.71%, respectively).
Conclusion: Using these local findings, the investigator developed a risk-based surveillance tool for long-term monitoring of patients with NLUTD in SA. This tool includes PBC, age, sex and VUR which had statistically significant findings. A longitudinal study is required to validate this tool.