脊髄損傷者における腎瘢痕のリスク因子：後ろ向き研究

Retrospective study.

To identify risk factors for renal scarring in individuals with spinal cord injury (SCI).

University-affiliated rehabilitation hospital in Yangsan, Republic of Korea.

We conducted a retrospective study involving 89 individuals with SCI. Only individuals with an SCI onset of at least six months prior were included to ensure recovery from initial detrusor atonicity. The participants were divided into two groups based on the presence of renal scars, as determined by 99mTc-dimercaptosuccinic acid scan. Demographic and urological data were collected, including the number of symptomatic urinary tract infections (UTIs) during the study period (2019-2023), bladder emptying methods, laboratory renal function tests, results from voiding cystourethrography, and urodynamic study metrics. We adjusted for suspected risk factors using multiple regression analysis.

In individuals with SCI, the frequency of symptomatic UTIs (P < 0.001) and female sex (P = 0.02) were significantly associated with the presence of renal scars compared to those without scars. Following adjustment using multiple logistic regression analysis, the history of symptomatic UTIs emerged as the strongest risk factor for renal scarring, with an odds ratio of 3.9 (95% confidence interval: 1.27-11.97, P = 0.021). Using a model based on that predictor, the analysis revealed a predictive capacity with an AUC of 0.711.

Our study is the first to identify risk factors for renal scarring by analyzing demographic and urological parameters in individuals with SCI, with symptomatic UTI frequency emerging as the strongest risk factor. Our findings suggest that there may be unique, yet undetermined, pathophysiological mechanisms underlying renal scarring in the SCI population.