title: Risk factors for renal function impairment in a series of 502 patients born with spinal dysraphisms.
abstract: OBJECTIVE
  To evaluate the risk of renal damage in a large series of patients affected by spinal dysraphism.
  
  
  METHODS
  Renal function was studied in 502 spinal dysraphisms treated over the last 25 years in a single center: 283 meningomyelocele (MMC), 90 caudal regression syndrome (CRS) and 129 spinal lipoma (SL) cases. In patients with normal and impaired renal function, we compared congenital renal anomalies, vesicoureteric reflux, bladder voiding pattern and upper tract dilatation, analyzing the results with the Fisher test.
  
  
  RESULTS
  Neuropathic bladder was observed in 97% of MMC, 60% of CRS, and 39% of SL cases. There was some degree of renal function impairment in 19 MMC (6.7%), 11 CRS (12%, increased to 20% if considering only neuropathic bladder patients), and two SL (1.5%) cases. Renal agenesis was more frequent in CRS (13%), but was not associated with decreased renal function. Overall, vesicoureteric reflux and upper tract dilatation were more frequent in patients with renal damage. Insufficient bladder voiding was statistically associated with renal damage only in the CRS population. Intermittent catheterization did not represent a protective factor against renal damage in patients able to void without significant residual urine.
  
  
  CONCLUSIONS
  This study has increased our understanding of the prognostic risk factors for renal deterioration. More prospective studies are necessary to confirm these results and correlate treatment with renal outcome.
authors.affiliation: Pediatric Surgery Unit, G. Gaslini Institute, Genova, Italy. micheletorre@hotmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Torre
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bisio
authors.forename: Piero
authors.initials: P
authors.lastname: Scarsi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Piatelli
authors.forename: Armando
authors.initials: A
authors.lastname: Cama
authors.forename: Piero
authors.initials: P
authors.lastname: Buffa
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004065:Digestive System Abnormalities / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities; D007677:Kidney Function Tests; D008067:Lipoma / Q000150:complications; D008297:Male; D008588:Meningocele; D008591:Meningomyelocele / Q000150:complications; D011379:Prognosis; D012007:Rectum / Q000002:abnormalities / Q000503:physiopathology; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D012445:Sacrococcygeal Region / Q000002:abnormalities; D012447:Sacrum / Q000002:abnormalities / Q000503:physiopathology; D016135:Spinal Dysraphism / Q000150:complications*; D013125:Spinal Neoplasms / Q000150:complications; D013595:Syringomyelia / Q000150:complications / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult