Journal of pediatric urology · 2025
Glomerular Filtration Rate (GFR) measures in young children with cloacal malformations indicate early baseline renal dysfunction which is independently associated with congenital upper urinary tract anomalies.
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Staniorski Christopher, Corbett Christopher, Hisam Butool, Bowser Melanie, Mayhew Allison, Ho Christina P, Pohl Hans G, Feng Christina, Badillo Andrea, Levitt Marc A, Meyers Melissa R, Varda Briony K
Аннотация
BACKGROUND: Children with cloacal malformations have high rates of congenital anomalies of the genitourinary tract, voiding dysfunction and subsequent renal dysfunction. Rigorous study of early renal function in this population has not been previously published.
OBJECTIVE: We aimed to characterize the baseline renal function of this cohort in early childhood and identify demographic, clinical and anatomical factors associated with lower baseline renal function.
STUDY DESIGN: A prospectively maintained institutional database of patients with cloaca enrolled between 2020 and 2025 was used to track those undergoing primary repair or revision. Patients were excluded if they had missing post-operative renal function measurements or a primary diagnosis of cloacal exstrophy. The primary outcome was estimated glomerular filtration rate (eGFR).
RESULTS: 52 patients met inclusion criteria. The median age at initial evaluation was 0.8 years (range 0.1-10.1) while the median age at last follow up was 1.6 years (range 0.3-10.3). Anatomic characteristics included 21 (40 %) with a complex cloaca (common channel [CC] length ≥3 cm), 26 (50 %) born with hydrocolpos, 48 (92 %) with an upper urinary tract anomaly (UTA) and 23 (44 %) with a severe UTA (defined as high grade hydroureteronephrosis [SFU grade 4], vesicoureteral reflux [grade IV-V] and/or solitary kidney with an ipsilateral anomaly). The median eGFR at the most recent evaluation was 82 ml/min/1.73 m2 (IQR 64-101). 30 patients (58 %) had at least chronic kidney disease (CKD) stage 2, but only 4 (8 %) had CKD stage 3b or greater. In unadjusted analyses, public insurance, increasing CC length, decreasing urethral length, urethral atresia, and upper UTAs were associated with decreased eGFR. Only public insurance status and severe UTAs were independently associated with decreased eGFR.
DISCUSSION: While many elements of cloacal anatomy were associated with eGFR, on adjusted analysis, only severe upper UTAs and insurance status remained associated. These data capture a relatively young cohort and suggest that early renal dysfunction is driven by congenital renal anomalies. Patients may develop voiding dysfunction and/or urinary tract infections that potentiate renal disease in this context. However, patients may also have intrinsic renal disease that is unmasked with somatic growth in late childhood and adolescence. Both scenarios must be anticipated and managed.
CONCLUSIONS: This study affirms a high rate of early renal dysfunction in this population and identifies renal anomalies as an important anatomic factor. These results emphasize the need for careful bladder management and renal surveillance protocols to reduce progression of renal disease.
OBJECTIVE: We aimed to characterize the baseline renal function of this cohort in early childhood and identify demographic, clinical and anatomical factors associated with lower baseline renal function.
STUDY DESIGN: A prospectively maintained institutional database of patients with cloaca enrolled between 2020 and 2025 was used to track those undergoing primary repair or revision. Patients were excluded if they had missing post-operative renal function measurements or a primary diagnosis of cloacal exstrophy. The primary outcome was estimated glomerular filtration rate (eGFR).
RESULTS: 52 patients met inclusion criteria. The median age at initial evaluation was 0.8 years (range 0.1-10.1) while the median age at last follow up was 1.6 years (range 0.3-10.3). Anatomic characteristics included 21 (40 %) with a complex cloaca (common channel [CC] length ≥3 cm), 26 (50 %) born with hydrocolpos, 48 (92 %) with an upper urinary tract anomaly (UTA) and 23 (44 %) with a severe UTA (defined as high grade hydroureteronephrosis [SFU grade 4], vesicoureteral reflux [grade IV-V] and/or solitary kidney with an ipsilateral anomaly). The median eGFR at the most recent evaluation was 82 ml/min/1.73 m2 (IQR 64-101). 30 patients (58 %) had at least chronic kidney disease (CKD) stage 2, but only 4 (8 %) had CKD stage 3b or greater. In unadjusted analyses, public insurance, increasing CC length, decreasing urethral length, urethral atresia, and upper UTAs were associated with decreased eGFR. Only public insurance status and severe UTAs were independently associated with decreased eGFR.
DISCUSSION: While many elements of cloacal anatomy were associated with eGFR, on adjusted analysis, only severe upper UTAs and insurance status remained associated. These data capture a relatively young cohort and suggest that early renal dysfunction is driven by congenital renal anomalies. Patients may develop voiding dysfunction and/or urinary tract infections that potentiate renal disease in this context. However, patients may also have intrinsic renal disease that is unmasked with somatic growth in late childhood and adolescence. Both scenarios must be anticipated and managed.
CONCLUSIONS: This study affirms a high rate of early renal dysfunction in this population and identifies renal anomalies as an important anatomic factor. These results emphasize the need for careful bladder management and renal surveillance protocols to reduce progression of renal disease.