Renal failure in patients with neurogenic lower urinary tract dysfunction

People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lower urinary tract dysfunction (NLUTD). This encompasses detrusor hyperreflexia with or without detrusor sphincter dyssynergia and hypo- or acontractility. Their effects undermine safe, effective and controlled storage and voiding of urine and predispose to reflux nephropathy. Therefore, patients in these diagnostic groups with NLUTD would be expected to have increased risk of renal failure. The aim of this study was to quantify this risk using the General Practice Research Database (GPRD). All patients registered in the database between 1994 and 1997 and aged 10-69 were included in the study. The prevalence and incidence of renal failure and renal replacement therapy in the general population was ascertained, as was the prevalence of multiple sclerosis, paraplegia and neural tube defects. The prevalence of renal failure in each of the special populations was then compared with the prevalence in the unaffected general population. The age-standardised prevalence of renal failure in the GPRD population aged 10-69 years was 14 per 10,000. The rate ratio of renal failure compared with the general population in each of the years 1994-1997 for neural tube defects ranged between males (M) 6.8-9.0 and females (F) 9.2-11.5, for paraplegia M 4.1-9.0, F 4.0-7.0, and for multiple sclerosis M 0.4-1.3, F 0.5-2.2. As expected, people with paraplegia or neural tube defects were found to have a substantially increased risk of renal failure compared with the general population. We could not demonstrate an increased risk of renal failure in people with multiple sclerosis. We believe this finding requires further study, but may reflect a problem in the recognition of renal failure in this group of patients. We recommend that all three patient groups should be regularly screened so that renal impairment may be detected prior to the development of renal failure.