Renal Outcomes and Predictors in Spina Bifida Children: A 10-year Review in Two Tertiary Hospitals

Objective: The study aims to determine long-term renal outcomes and their predictors in spina bifida (SB) children. Methods: A 10-year retrospective record review was conducted involving paediatric patients who were diagnosed with SB. Baseline data was recorded,including type of SB, level of spinal lesion, neurological sequelae (bladder, bowel incontinence, ability to walk), renal function and imaging findings (ultrasound, MCUG, DMSA). The socio-demographic characteristics were described using descriptive analysis. Multiple logistic regression analyses were used to determine the association between significant predictors for renal scarring and chronic kidney disease (CKD). Results: A total of 60 SB children with a mean age 11.8±3.8 years during data collection were recruited. Most of the lesions were at L5 and below. The majority were complicated by urinary (88.3%) and bowel incontinence (93.3%). Despite the majority performing clean intermittent catheterization (CIC), almost two-thirds had symptomatic urinary tract infections (UTI). One-third of them had both hydroureter and hydronephrosis. 50% of them were shown to have vesicoureteric reflux. Half of the cohort progressed to CKD. The odds of developing renal scarring were 8.3 times higher in females compared to males (p = 0.046). The presence of hydroureter and hydronephrosis on ultrasound was identified as a significant factor in the development of CKD (OR 3.8; 95% CI 1.239, 11.385). Conclusion: The presence of hydroureter and hydronephrosis were the predictors for the development of CKD, whereas female gender is associated with renal scarring.