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Non-neurogenic bladder and chronic renal insufficiency in childhood
1Clementine Children's Hospital, Frankfurt/M, Germany.
Insights
Children with urinary retention, a functional voiding disorder, risk chronic renal insufficiency (CRI). Early intervention with bladder training and psychotherapy can prevent severe kidney damage and stabilize renal function.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Functional voiding disorders are common in children.
- While typically not leading to upper urinary tract damage, a subset of children are at risk for chronic renal insufficiency (CRI).
Observation:
- Nine girls with psychogenic urine retention, excluding neurogenic or anatomical causes, were monitored for 5 years.
- Clinical presentation included diurnal and nocturnal enuresis, with urinary retention identified via abnormal uroflow curves.
Findings:
- One patient developed end-stage renal disease, five progressed to CRI, and the remaining three had severe kidney scarring despite maintained function.
- All patients exhibited bladder and upper urinary tract dilation. Six had vesicoureteral reflux, and three had ureterovesical junction obstruction.
- Hypertension developed in three patients, with one experiencing a hypertensive crisis, microangiopathic anemia, and acute renal failure.
Implications:
- Psychogenic urine retention in girls, often associated with psychological distress and family issues, can lead to significant renal damage.
- Prompt diagnosis and management, including bladder training, intermittent catheterization, and psychotherapy, are crucial for preserving renal function.
- This syndrome should be considered in girls presenting with asymptomatic bacteriuria and urinary retention.
Abstract:
Functional voiding disorders and urinary tract infections are common in childhood, but are usually not accompanied by upper urinary tract deterioration. Nevertheless a small group of children remain at risk of developing chronic renal insufficiency (CRI). Clinically these children present day and night wetting. The most important parameter, however, is urinary retention which is reflected by an abnormal voiding pattern in the uroflow curve. After ruling out patients with neurogenic or anatomical disorders, nine girls with psychogenic urine retention were observed for 5 years. Terminal renal insufficiency was seen in one, CRI in five patients and in three patients the kidney function could be maintained, but they all had severe scarring of at least one kidney. Furthermore, all revealed a dilation of the bladder and the upper urinary tract. Vesicoureteral reflux occurred in six and obstruction of the ureterovesical junction in three patients. Two girls underwent repeated reflux surgery resulting in a rapid deterioration of renal function. Three patients developed hypertension and one had a hypertensive crisis with microangiopathic anaemia and acute renal failure. Psychogenic disorders and problematic family settings were observed in all cases. Bladder training, transitory suprapubic catheters, intermittent catheterisation, medication and psychotherapy can avoid severe kidney damage and achieve a stabilisation of renal function. It is important to bear this syndrome in mind when evaluating girls with asymptomatic bacteriuria and urinary retention.