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Follow-up of spina bifida children with and without upper renal tract changes at birth
Insights
Children with spina bifida and upper renal tract (URT) changes at birth have similar outcomes to those developing URT changes later. Early detection and monitoring are crucial for managing spina bifida complications.
Area of Science:
- Pediatric Nephrology
- Spinal Cord Medicine
- Urology
Background:
- Spina bifida is a congenital condition affecting spinal cord development.
- Upper renal tract (URT) changes can be present at birth or develop later in children with spina bifida.
- Understanding the long-term prognosis of URT changes is vital for patient management.
Purpose of the Study:
- To compare the outcomes of upper renal tract (URT) changes in children with spina bifida based on their presence at birth versus later development.
- To evaluate the management strategies and their effectiveness for URT changes in this population.
Main Methods:
- Retrospective analysis of two groups of children with spina bifida: Group 1 (normal URT at birth, n=148) and Group 2 (URT changes at birth, n=24).
- Mean follow-up periods of 131 months (Group 1) and 115 months (Group 2).
- Assessment of URT changes development, progression, spontaneous improvement, need for intervention, and renal function deterioration.
Main Results:
- 28% of children in Group 1 developed URT changes later, with a median time of 33 months from birth and 16 months from the last normal assessment.
- In Group 2, 8 patients' URT changes deteriorated, while 12 improved spontaneously, though 5 of these later deteriorated.
- Renal function deteriorated in 3 patients, including one with renal failure.
- Sacral and thoraco-lumbar spinal lesions were most commonly associated with URT changes.
Conclusions:
- The long-term prognosis for children with spina bifida and URT changes present at birth is comparable to those who develop changes later.
- Early detection and ongoing monitoring are essential for identifying and managing URT complications in spina bifida.
- Spinal lesion location is a significant factor associated with URT changes in spina bifida.
Abstract:
The aim of this study was to assess 2 groups of children with spina bifida; one with and the other without upper renal tract (URT) changes at birth and to evaluate the outcome of their management. In Group 1, there were 148 patients who had normal URT at birth. They were studied for a mean follow-up of 131 months. Twenty-eight per cent developed URT changes in later life. The median time interval for URT changes to develop between birth and the first assessment which showed abnormal finding, was 33 months and between the last normal URT assessment and the development of URT changes, was 16 months. Six patients with URT changes were treated conservatively and 36 required intervention. Twenty-eight of 42 patients showed initial improvement of URT changes but 25 subsequently deteriorated. In 3 patients renal function deteriorated with renal failure in one and renal impairment in 2. In Group 2, 24 patients who had URT changes present at birth were also studied for a mean follow-up of 115 months. The URT changes in 8 patients deteriorated after the initial assessment over a median time of 15 months. Twelve patients' URT changes improved spontaneously without active intervention over a median time interval of 16 months but 5 subsequently deteriorated. Overall, the prognosis of children with URT changes at birth did not seem to be any worse than children developing changes later in life. Lesions of sacral and thoraco-lumbar regions of the spine were most commonly associated with URT changes.(ABSTRACT TRUNCATED AT 250 WORDS)