Following a strict renal protection protocol in cloacal malformations: A descriptive analysis

Area of Science:

• Pediatric Urology
• Nephrology
• Congenital Malformations

Background:

• Cloacal malformations pose a significant risk of renal dysfunction in children, with historical incidence rates up to 50%.
• Effective management strategies are crucial to mitigate renal impairment in this vulnerable population.
• The long-term impact of a dedicated renal protection protocol on renal function in these patients remains to be fully elucidated.

Purpose of the Study:

• To evaluate the incidence of renal dysfunction in children with cloacal malformations managed under a strict renal protection protocol.
• To assess the effectiveness of the protocol in preventing or delaying the progression of renal impairment.

Main Methods:

• A prospective database of 105 children with cloacal malformations managed since the implementation of a renal protection protocol was reviewed.
• The protocol included regular laboratory evaluation, appropriate surgical approach selection, proactive imaging, and early catheterization.
• Renal dysfunction was defined as CKD grade 3b or higher, or need for renal replacement therapy (RRT) or transplantation; GFR was calculated using the Schwartz formula.

Main Results:

• The median follow-up was 4.2 years, with 5.7% of children experiencing renal dysfunction at the most recent follow-up.
• Only 2.9% of children progressed from normal renal function at initial evaluation to renal dysfunction.
• No child with initially normal renal function progressed to require dialysis or transplantation.

Conclusions:

• A strict, multi-disciplinary renal protection protocol is associated with a low incidence (2.9%) of progressive renal dysfunction in children with cloacal malformations.
• The majority of children who developed renal dysfunction had pre-existing kidney impairment at presentation.
• This protocol suggests that preservation of renal function in early childhood is achievable.