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Lower urinary tract symptoms in children and adolescents with chronic renal failure
Helena Oborn1, Maria Herthelius
1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Children's Hospital, Karolinska University Hospital Huddinge, Stockholm, Sweden. helena.oborn@karolinska.se
Insights
Lower urinary tract symptoms are common in children with chronic kidney disease before a kidney transplant. Early screening for bladder dysfunction is crucial for all pediatric patients, regardless of underlying cause, to ensure optimal outcomes.
Area of Science:
- Pediatric Nephrology
- Urology
- Transplantation
Background:
- Lower urinary tract symptoms (LUTS) are frequently observed in children post-renal transplantation.
- The pre-transplant presence and prevalence of LUTS in pediatric patients remain incompletely understood.
Purpose of the Study:
- To evaluate bladder function in children with chronic kidney disease prior to renal transplantation.
- To determine the incidence of lower urinary tract symptoms before kidney transplantation in pediatric patients.
Main Methods:
- A cohort of 40 children (ages 5-18) with a glomerular filtration rate < 50 ml/min/1.73 m² underwent assessment.
- Bladder function was evaluated using a detailed medical history, bladder diary, uroflowmetry, and bladder ultrasound.
Main Results:
- 100% of children with urological disorders and 59% with non-urological disorders exhibited signs of bladder dysfunction.
- Prevalence of incontinence was 20%, abnormal bladder capacity 47.5%, discontinuous flow 20%, and significant residual urine 15%.
- Prior febrile urinary tract infection was more common in children with bladder dysfunction.
Conclusions:
- Lower urinary tract symptoms are prevalent in children with chronic renal failure awaiting transplantation.
- Screening for bladder dysfunction is essential in all pediatric renal failure patients, including those with non-urological conditions, for pre-transplant correction.
Purpose:
Lower urinary tract symptoms are common in children after renal transplantation. However, it is unclear whether lower urinary tract symptoms are present before transplantation or appear postoperatively. We sought to evaluate bladder function in children before renal transplantation.
Materials And Methods:
A total of 40 children 5 to 18 years old with a glomerular filtration rate of less than 50 ml per minute per 1.73 m(2) were consecutively enrolled in the study from 2006 to 2008. Bladder function was assessed by a comprehensive history, bladder diary, uroflowmetry and bladder ultrasound.
Results:
Of the patients 20% suffered from incontinence, 47.5% had bladder capacity larger than expected for age, 20% had discontinuous flow and 15% had residual urine 20 ml or greater. Signs consistent with bladder dysfunction (incontinence, abnormal bladder capacity, discontinuous urinary flow and/or residual urine) were observed in 13 of 13 children (100%) with urological disorders and 16 of 27 (59%) with nonurological disorders. Polyuria was present in 39% of the patients. Prior febrile urinary tract infection was significantly more common in children with vs without signs of bladder dysfunction.
Conclusions:
Lower urinary tract symptoms are common in children with chronic renal failure. Screening for bladder dysfunction is important not only in children with urological disorders, but also in those with nonurological disorders, so that dysfunction can be corrected before transplantation.
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