Incidence of Impaired Renal Function and Clinical Characteristics of Children 1 to 5 Years After Repair of Myelomeningocele at the Kenyatta National Hospital

Abstract

Background: Myelomeningocele (MMC) is a defect of primary neurulation that manifests at birth as a cleft in the vertebral column and the overlying skin resulting in exposure of spinal neural tissues, a persistent neural placode, and exposed surrounding meninges with resultant neurological impairment. It results in impaired bladder function, resulting in both storage and voiding complications. These complications are primarily treated by the practice of intermittent catheterization (IC). This practice should be started early in life to prevent or slow down the development of chronic kidney disease which will manifest as impaired renal function. Objective: To determine the incidence of impaired renal function and clinical characteristics of children at 1 to 5 years after repair of myelomeningocele in children at the Kenyatta National Hospital (KNH). Materials and Methods: This was 3-months long descriptive cross-sectional study on the incidence of impaired renal function and clinical characteristics of children at one to five years after undergoing myelomeningocele at the Kenyatta National Hospital (KNH). A consecutive sampling technique was employed to recruit subjects, whereby, every subject meeting the inclusion criteria and consent to the study was included. The data was collected using a data abstraction tool, that included demographic, clinical characteristics of the children, and serum creatinine for estimation of the glomerular filtration rate. Data management and results: Data was collected using predesigned data collection forms, then entered Stata version 24.0 Results: Seventy-seven (77) children underwent myelomeningocele repair within our study category from 1st January 2016 to 1st January 2021. Fourteen patients were reported dead by the relatives when contacted, and thirty-three (33) patients were lost to follow-up, due to either having no records of contacts or being unreachable by telephone contact found in the records. Thirty (30) children with myelomeningocele repaired within the last one to five years were recruited into the study and the results were analyzed. The mean age of the patients was 2.6 years (SD 0.9), whereas the median age was 2.6 years (Inter Quartile Range (IQR) 2.0 – 3.1). The youngest patient was 1.0 years while the oldest was 4.3 years. The male-to-female ratio was 1:1.31, with males 13 (43.3%), and females 17 (56.7%). All the children presented with urinary incontinence. Twenty-six (86.7%) had associated Hydrocephalus and had undergone ventriculoperitoneal shunting (VPS). Parents of 5 (16.7%) had Knowledge of Clean Intermittent Catheterization (CIC) and 25 (83.3%) parents did not know about CIC. No patient had urodynamic studies 30 (100.0%). Twenty-eight (93.3%) children had normal kidney function, Kidney Disease: Improving Global Outcomes (KDIGO) stage 1, whereas 2 (6.7%) had impaired renal function, KDIGO stage II Conclusion: This study shows that more female patients presented with myelomeningocele in this population. The incidence of renal impairment in the first 5 years was significant. with a majority neither having prior knowledge nor elementary education on the practice of Clean Intermittent Catherization (CIC) and its benefits. Hydrocephalus is a predominant associated presentation in patients with MMC all of whom had benefited from Cerebral Spinal Fluid (CSF) diversion