Renal and urologic manifestations of pediatric condition falsification/Munchausen by proxy

Renal and urologic problems in pediatric condition falsification (PCF)/Munchausen by proxy (MBP) can pose frustrating diagnostic and management problems. Five previously unreported victims of PCF/MBP are described. Symptoms included artifactual hematuria, recalcitrant urinary infections, dysfunctional voiding, perineal irritation, glucosuria, and "nutcracker syndrome", in addition to alleged sexual abuse. Falsifications included false or exaggerated history, specimen contamination, and induced illness. Caretakers also intentionally withheld appropriately prescribed treatment. Children underwent invasive diagnostic and surgical procedures because of the falsifications. They developed iatrogenic complications as well as behavioral problems stemming from their abuse. A PCF/MBP database was started in 1995 and includes the characteristics of 135 PCF/MBP victims examined by the first author between 1974 and 2006. Analysis of the database revealed that 25% of the children had renal or urologic issues. They were the presenting/primary issue for five. Diagnosis of PCF/MBP was delayed an average of 4.5 years from symptom onset. Almost all patients were victimized by their mothers, and maternal health falsification and somatization were common. Thirty-one of 34 children had siblings who were also victimized, six of whom died. In conclusion, falsifications of childhood renal and urologic illness are relatively uncommon; however, the deceits are prolonged and tortuous. Early recognition and intervention might limit the harm.