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Assessment of Renal Deterioration and Associated Risk Factors in Patients With Multiple Sclerosis

Published:September 26, 2018DOI:https://doi.org/10.1016/j.urology.2018.09.014

      Abstract

      Objective

      To evaluate predictors of renal deterioration (RD) in patients with multiple sclerosis (MS) at a tertiary referral center.

      Methods

      We reviewed adult patients with MS presenting for evaluation of lower urinary tract symptoms, with baseline urodynamic study (UDS) and either serum creatinine (SCr) or renal ultrasound, from a prospectively maintained database, and excluded patients with abnormal renal function. RD was defined as doubled SCr, new hydronephrosis, or renal atrophy on follow-up ultrasound. Demographic and UDS parameters were evaluated in multivariable models of RD.

      Results

      From 1999 to 2016, 660 patients were evaluated, and 355 met criteria with median follow-up of 79 months. SCr doubled in 8 patients, 4 had decline by renal ultrasound, and 1 by both (3%). Overall, 46 patients met less strict criteria of decrease in estimated glomerular filtration rate by ≥30%. Using the less rigid criterion, detrusor overactivity (DO) remained associated with RD on multivariable analysis. Eleven of 355 patients had RD by either imaging or doubled Cr, with which only history of diabetes mellitus and nephrolithiasis were associated.

      Conclusion

      By strict criteria, the rate of RD in patients with neurogenic bladder due to MS was low (3%) at intermediate-term follow-up and was not associated with UDS parameters. Using more liberal criteria, DO was associated with deterioration, suggesting that study of the impact of more aggressive control of DO in this population may be warranted.
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      References

        • Phe V
        • Chartier-Kastler E
        • Panicker JN
        Management of neurogenic bladder in patients with multiple sclerosis.
        Nat Rev Urol. 2016; 13: 275-288
        • Stoffel JT
        Chronic urinary retention in multiple sclerosis patients: physiology, systematic review of urodynamic data, and recommendations for care.
        Urol Clin North Am. 2017; 44: 429-439
        • Harris CJ
        • Lemack GE
        Neurourologic dysfunction: evaluation, surveillance, and therapy.
        Curr Opin Urol. 2016; 26: 290-294
        • Fletcher SG
        • Dillon BE
        • Gilchrist AS
        • et al.
        Renal deterioration in multiple sclerosis patients with neurovesical dysfunction.
        Mult Scler. 2013; 19: 1169-1174
        • Ineichen BV
        • Schneider MP
        • Hlavica M
        • Hagenbuch N
        • Linnebank M
        • Kessler TM
        High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis.
        Mult Scler. 2017; 1352458517703801
        • Castel-Lacanal E
        • Game X
        • Clanet M
        • et al.
        Urinary complications and risk factors in symptomatic multiple sclerosis patients. Study of a cohort of 328 patients.
        Neurourol Urodyn. 2015; 34: 32-36
        • Nseyo U
        • Santiago-Lastra Y
        Long-term complications of the neurogenic bladder.
        Urol Clin North Am. 2017; 44: 355-366
        • Lemack GE
        • Frohman E
        • Ramnarayan P
        Women with voiding dysfunction secondary to bladder outlet dyssynergia in the setting of multiple sclerosis do not demonstrate significantly elevated intravesical pressures.
        Urology. 2007; 69: 893-897
        • De Ridder D
        • Van Der Aa F
        • Debruyne J
        • et al.
        Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis.
        Clin Neurol Neurosurg. 2013; 115: 2033-2040
        • Abrams P
        • Cardozo L
        • Fall M
        • et al.
        The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.
        Neurourol Urodyn. 2002; 21: 167-178
        • Coresh J
        • Turin TC
        • Matsushita K
        • et al.
        Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.
        JAMA. 2014; 311: 2518-2531
        • Jameson RM
        Management of the bladder in non-traumatic paraplegia.
        Paraplegia. 1974; 12: 92-97
        • Lawrenson R
        • Wyndaele JJ
        • Vlachonikolis I
        • Farmer C
        • Glickman S
        Renal failure in patients with neurogenic lower urinary tract dysfunction.
        Neuroepidemiology. 2001; 20: 138-143
        • Winters JC
        • Dmochowski RR
        • Goldman HB
        • et al.
        Urodynamic studies in adults: AUA/SUFU guideline.
        J Urol. 2012; 188: 2464-2472
        • Krhut J
        • Hradilek P
        • Zapletalova O
        Analysis of the upper urinary tract function in multiple sclerosis patients.
        Acta Neurol Scand. 2008; 118: 115-119
        • Onal B
        • Siva A
        • Buldu I
        • Demirkesen O
        • Cetinel B
        Voiding dysfunction due to multiple sclerosis: a large scale retrospective analysis.
        Int Braz J Urol. 2009; 35: 326-333
        • Betts CD
        • D'Mellow MT
        • Fowler CJ
        Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis.
        J Neurol Neurosurg Psychiatry. 1993; 56: 245-250
        • Blaivas JG
        • Barbalias GA
        Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition.
        J Urol. 1984; 131: 91-94
        • Sirls LT
        • Zimmern PE
        • Leach GE
        Role of limited evaluation and aggressive medical management in multiple sclerosis: a review of 113 patients.
        J Urol. 1994; 151: 946-950
        • Lemack GE
        • Frohman EM
        • Zimmern PE
        • Hawker K
        • Ramnarayan P
        Urodynamic distinctions between idiopathic detrusor overactivity and detrusor overactivity secondary to multiple sclerosis.
        Urology. 2006; 67: 960-964
        • Groen J
        • Pannek J
        • Castro Diaz D
        • et al.
        Summary of European Association of Urology (EAU) guidelines on neuro-urology.
        Eur Urol. 2016; 69: 324-333