Publication: Meningomiyeloselli Hastaların Yürüyebilme Durumunun Böbrek Hastalığı ile İlişkili Klinik ve Radyolojik Bulgulara Etkisi Var mı?
Abstract
AMAÇ: Meningomiyeloselli (MMS) hastalarda böbrek sorunları, hastaların morbidite ve mortalitelerinde önemli yer tutar. Bu çalışmanın amacı, MMS'li hastaların yürüyebilme durumlarının böbrek hastalıkları ile ilgili klinik ve radyolojik bulgulara etkisinin araştırılmasıdır. GEREÇ ve YÖNTEMLER: Marmara Üniversitesi Çocuk Nefrolojisi Polikliniğinde 2005-2010 yıllarında izlenen MMS'li 83 hastanın kayıtları geriye dönük olarak değerlendirildi. Hastalar yürüyebilme durumlarına göre bağımsız yürüyebilenler, yardımla yürüyebilenler ve alt ekstremitelerini hareket ettiremeyenler olarak üç gruba ayrıldı. BULGULAR: Hastaların yaş ortalaması 7,1±0,61 yıl, ortanca izlem süresi 58 (32-97) ay idi. Hastalardan 37'si (%44,6) ilk üç günde ameliyat edilmişti. Seksen hastada lomber, üçünde torakal MMS vardı. Hastaların 16'sında (%19,3) tek yanlı, yedisinde (%8,4) böbreklerinde iki yanlı skar, 19'unda (%22,9) vezikoüreteral refl ü (VUR) saptandı. Altmış bir hastanın (%73,5) alt ekstremitelerini hiç hareket ettiremediği, 14'ünün (%16,9) yardımla yürüyebildiği ve sekizinin (%9,6) bağımsız yürüyebilir olduğu görüldü. Bir yaşından önce izlemine başlanan hastalarda USG'de hidronefroz varlığı ile işemeli sistoüretrografi 'de mesanenin deforme, trabeküle görünümü daha az gözlendi. Beşi yürüyemeyen grupta olan altı hastanın glomerül fi ltrasyon hızı 80 ml/dakika/1,73m² altındaydı. Yürüyebilme durumu ile hastaların fi zik ve radyolojik bulguları ve böbrek işlevleri arasında anlamlı ilişki bulunmadı. SONUÇ: Yürüyebilme yeteneğinin, MMS'li hastaların klinik bulgular ve böbrek işlevleri üzerine etkili olmadığı, erken izlemin, hidronefroz ve mesanede trabekülasyon gelişimini geciktirebileceği, özellikle ilk üç günde ameliyat edilen hastalarda daha iyi izlem yapılabildiği sonucuna varıldı.
OBJECTIVE: The aim of this study is to evaluate the infl uence of the ambulatory status of children with MMC on renal functions, clinical and radiological fi ndings. MATERIAL and METHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classifi ed as independent walkers (walks without assistive appliances), assisted walkers (requires walking aid), and non-ambulatory (wheelchair bound) and the patient characteristics were evaluated according to the ambulatory status. RESULTS: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97) months. Thirtyseven patients (44.6%) had been operated in the fi rst three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5%) were non-ambulatory, 14 (16.9%) were assisted walkers and eight (9.6%) were independent walkers. GFR was less than 80 ml/minute/1.73m² in six patients. There were no relation between ambulatory status and patients' renal functions, radiological and clinical fi ndings. CONCLUSION: Ambulatory status does not infl uence renal functions, clinical and radiological fi ndings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the fi rst three days of life were more compliant with regular follow-ups.
OBJECTIVE: The aim of this study is to evaluate the infl uence of the ambulatory status of children with MMC on renal functions, clinical and radiological fi ndings. MATERIAL and METHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classifi ed as independent walkers (walks without assistive appliances), assisted walkers (requires walking aid), and non-ambulatory (wheelchair bound) and the patient characteristics were evaluated according to the ambulatory status. RESULTS: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97) months. Thirtyseven patients (44.6%) had been operated in the fi rst three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5%) were non-ambulatory, 14 (16.9%) were assisted walkers and eight (9.6%) were independent walkers. GFR was less than 80 ml/minute/1.73m² in six patients. There were no relation between ambulatory status and patients' renal functions, radiological and clinical fi ndings. CONCLUSION: Ambulatory status does not infl uence renal functions, clinical and radiological fi ndings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the fi rst three days of life were more compliant with regular follow-ups.