Background. To describe the extent of renal disease in Ugandan children surviving at least ten years after spina bifida repair and\nto investigate risk factors for renal deterioration in this cohort. Patients and Methods. Children who had undergone spina bifida\nrepair at CURE Childrenâ??s Hospital of Uganda between 2000 and 2004 were invited to attend interview, physical examination,\nrenal tract ultrasound, and a blood test (creatinine).Medical records were retrospectively reviewed. The following were considered\nevidence of renal damage: elevated creatinine, hypertension, and ultrasound findings of hydronephrosis, scarring, and discrepancy\nin renal size >1cm. Female sex, previous UTI, neurological level, mobility, detrusor leak point pressure, and adherence with clean\nintermittent catheterisation (CIC) were investigated for association with evidence of renal damage. Results. 65 of 68 children aged\n10â??14 completed the assessment.Themajority (83%) reported incontinence. 17 children (26%) were performing CIC. One child had\nelevated creatinine. 25 children (38%) were hypertensive. There was a high prevalence of ultrasound abnormalities: hydronephrosis\nin 10 children (15%), scarring in 42 (64%), and >1cm size discrepancy in 28 (43%). No children with lesions at S1 or below had\nhydronephrosis (p = 0.025), but this group had comparable prevalence of renal size discrepancy, scarring, and hypertension to\nthose children with higher lesions. Conclusions. Incontinence, ultrasound abnormalities, and hypertension are highly prevalent in\na cohort of Ugandan children with spina bifida, including those with low neurological lesions.These findings support the early and\nuniversal initiation of CIC with anticholinergic therapy in a low-income setting.
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