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Chronic pyelonephritis in association with neuropathic bladder
S Brown1, D Marshall, D Patterson
1Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, UK.
Summary
Chronic pyelonephritis (CPN) affects 39% of children with meningomyelocele (MMC), particularly girls. While renal failure is less common now, CPN remains a significant risk, often linked to vesico-ureteric reflux (VUR).
Area of Science:
- Pediatric Nephrology
- Urology
- Developmental Pediatrics
Background:
- Historically, chronic pyelonephritis (CPN) leading to renal failure was a common cause of mortality in children with meningomyelocele (MMC).
- Advances in management have reduced the incidence of renal failure, but CPN remains a persistent clinical challenge in this population.
Purpose of the Study:
- To investigate the prevalence and associated factors of chronic pyelonephritis (CPN) in a cohort of children with meningomyelocele (MMC).
- To understand the relationship between CPN and other urological conditions in children with MMC.
Main Methods:
- A retrospective analysis of 100 children diagnosed with meningomyelocele (MMC).
- Assessment of CPN prevalence, gender distribution, and correlation with vesico-ureteric reflux (VUR) and bladder pressure.
Main Results:
- 39% of children with MMC in the study cohort had CPN.
- CPN was significantly more prevalent in girls than in boys.
- A strong association was observed between CPN and vesico-ureteric reflux (VUR), with no link to elevated bladder pressure.
- Most CPN cases were diagnosed in children under 4 years old, though kidney damage can progress.
Conclusions:
- Chronic pyelonephritis (CPN) remains a significant concern in children with meningomyelocele (MMC), despite improved management of renal failure.
- Vesico-ureteric reflux (VUR) is a key factor associated with CPN in this population.
- Early detection and management of CPN and VUR are crucial to prevent long-term kidney damage, even if renal failure is postponed to adulthood.