Beneficial effects of continuous overnight catheter drainage in children with polyuric renal failure.

Abstract

To determine the possible beneficial effect of providing decompression of the collecting system by continuous overnight catheter drainage (COCD) in children with progressive renal disease and dysfunctional bladder syndrome, commonly associated with polyuria which may overwhelm bladder capacity. COCD was used in seven patients (four boys) with progressive polyuric kidney failure associated with dysfunctional bladders (current age 18.7 years, SD 5; age at COCD 12 years, SD 6). Five children had surgical bladder augmentation and all were prescribed daytime intermittent catheterization (IC) for a mean (SD) of 4.7 (3.4) years before COCD. All had significant polyuria, with a mean (SD) urine output of 2370 (971) mL/m2 per day. The mean (SD) glomerular filtration rate at the start of COCD was 48 (21) mL/min/1.73 m2, which is currently stable in the five patients continuing treatment. The mean (SD) duration of COCD was 4.9 (2) years. One patient showed no improvement and had a pre-emptive transplant within 1.2 years; another was transplanted after 5.5 years. Six patients showed evidence of benefit from COCD, with significant attenuation in the slope of renal functional decay (P = 0.02) and a mean (sd) prolongation of the predicted time to end-stage renal disease of 12.2 (5.6) years (P < 0.002). Hospitalization for febrile urinary tract infections was decreased from a mean (sd) of 1.7 (1.4) to 0.4 (0.7) times (P = 0.03) in the first year of COCD and eliminated by the second year (P < 0.01). COCD of the dysfunctional bladder in patients with progressive polyuric renal failure appears to offer the potential for preserving kidney function in selected patients. It does not replace surgical bladder augmentation or daytime IC in the core management.