Renal failure in patients with neurogenic lower urinary tract dysfunction

People with multiple sclerosis, paraplegia and neural tube defects typicall y have neurogenic lower urinary tract dysfunction (NLUTD). This encompasses detrusor hyperreflexia with or without detrusor sphincter dyssynergia and hypo- or acontractility. Their effects undermine safe, effective and contro lled storage and voiding of urine and predispose to reflux nephropathy. The refore, patients in these diagnostic groups with NLUTD would be expected to have increased risk of renal failure. The aim of this study was to quantif y this risk using the General Practice Research Database (GPRD). All patien ts registered in the database between 1994 and 1997 and aged 10-69 were inc luded in the study. The prevalence and incidence of renal failure and renal replacement therapy in the general population was ascertained, as was the prevalence of multiple sclerosis, paraplegia and neural tube defects. The p revalence of renal failure in each of the special populations was then comp ared with the prevalence in the unaffected general population. The age-stan dardised prevalence of renal failure in the GPRD population aged 10-69 year s was 14 per 10,000. The rate ratio of renal failure compared with the gene ral population in each of the years 1994-1997 for neural tube defects range d between males (M) 6.8-9.0 and females (F) 9.2-11.5, for paraplegia M 4.1- 9.0, F 4.0-7.0, and for multiple sclerosis M 0.4-1.3, F 0.5-2.2. As expecte d, people with paraplegia or neural tube defects were found to have a subst antially increased risk of renal failure compared with the general populati on. We could not demonstrate an increased risk of renal failure in people w ith multiple sclerosis. We believe this finding requires further study, but may reflect a problem in the recognition of renal failure in this group of patients. We recommend that all three patient groups should be regularly s creened so that renal impairment may be detected prior to the development o f renal failure. Copyright (C) 2001 S.Karger AG, Basel.