NON-NEUROGENIC BLADDER AND CHRONIC RENAL-INSUFFICIENCY IN CHILDHOOD

Functional voiding disorders and urinary tract infections are common i n childhood, but are usually not accompanied by upper urinary tract de terioration. Nevertheless a small group of children remain at risk of developing chronic renal insufficiency (CRI). Clinically these childre n present day and night wetting. The most important parameter, however , is urinary retention which is reflected by an abnormal voiding patte rn 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, C RI 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 urin ary tract. Vesicoureteral reflux occurred in six and obstruction of th e ureterovesical junction in three patients. Two girls underwent repea ted reflux surgery resulting in a rapid deterioration of renal functio n. Three patients developed hypertension and one had a hypertensive cr isis with microangiopathic anaemia and acute renal failure. Psychogeni c disorders and problematic family settings were observed in all cases . Bladder training, transitory suprapubic catheters, intermittent cath eterisation, medication and psychotherapy can avoid severe kidney dama ge and achieve a stabilisation of renal function. It is important to b ear this syndrome in mind when evaluating girls with asymptomatic bact eriuria and urinary retention.