Long-Term Follow-Up Imperative for Minimizing Chronic Kidney Disease in Children with Cloaca

Published In July 2015
The Journal of Urology

Early interventions and long-term care strategies are crucial to maintaining renal function in children with chronic kidney disease.

This is particularly challenging among children who undergo complex pelvic reconstruction to repair persistent cloaca.

In this condition, the rectum, urethra and vagina form into one common channel, typically with a single opening at the normal site of the urethra. It is one of the most complex, and potentially fatal, anorectal malformations. It occurs in about one in 20,000 births.

Such children face a variety of long-term risks. However, a study published in The Journal of Urology, shows that aggressive bladder management helps prevent progressive renal injury as the child grows.

The team consisted of eight researchers from the Division of Urology and the Colorectal Center at Cincinnati Children’s. They tracked 44 girls who had undergone posterior sagittal anorecto-vagino-urethroplasty (PSAVUP) between 2006 and 2013.

PSAVUP is a common repair of cloacal malformations. The median age at the time of the procedure was 7 months; the median age at follow-up was 5 years.

Although one 2-year-old patient with stage IV of the disease ultimately required a kidney transplant, researchers found no patient with initial stage I to III whose condition had worsened with proactive bladder management.

The length of the common channel also mattered. Patients with a length of greater than 3.5 centimeters appeared to have an increased risk of neurogenic bladder.

“We work hard to manage bladder dysfunction and prevent urinary tract infections, which could lead to progressive kidney damage,” says W. Robert DeFoor, MD, MPH, director of clinical research in the Division of Urology. “We hope that keeping a close eye on urinary tract function, will help these children keep healthy kidneys for a lifetime.”