Impaired renal function in newly spinal cord injured patients improves in the chronic state--effect of clean intermittent catheterization?

PURPOSE: We investigated renal function in spinal cord injured subjects in relation to the level and completeness of injury and bladder emptying regimen in the acute and chronic stages.

MATERIALS AND

METHODS

A retrospective chart review was performed of 169 spinal cord injured subjects treated at the Spinal Cord Injury Unit, Sahlgrenska Hospital between 1985 and 2002. Renal function based on glomerular filtration rate was evaluated by chromium ethylenediaminetetraacetic acid clearance 3 to 4 months after injury and at followup 3 to 5 years after injury.

RESULTS

The glomerular filtration rate was lower than expected in the first investigation in the whole group (82% of the expected value). When divided according to level of lesion the figure was lower in the cervical (81%) and thoracic (88%) levels of the lesion and in the American Spinal Injury Association A group compared to the American Spinal Injury Association B-E group. In the second investigation we found a significant improvement in the whole group of 6%. When dividing the group according to bladder emptying regimen we found that in the group that emptied the bladder by clean intermittent catheterization glomerular filtration rate improved significantly (+7%).

CONCLUSIONS

Spinal cord injury affects renal function and has a deteriorating effect on glomerular filtration rate. The reduction is seen on the cervical and thoracic levels of injury and in complete injuries. Renal function improves with time after injury and improvement is seen most clearly in the group that uses clean intermittent catheterization as a bladder emptying method.