[Prognostics factors of renal failure in multiple sclerosis]

Abstract

Introduction: Urinary symptoms occur in 50 to 80% of patients with Multiple Sclerosis (MS). This study was conducted to determine prevalence of renal failure during MS follow-up and to investigate the correlation of these complications with disease characteristics and urodynamic findings.

Methods: One hundred and twenty-one consecutive patients have been followed for (MS) (61 men and 60 women) between 1995 and 2009 in our institution. The demographic findings of patients were documented. The history was obtained and a detailed neurological and urological physical examination was performed for all patients. Urological symptoms (urgency, frequency, urge incontinence, dysuria), urinary scores (UPS and International Consultation on Incontinence Questionnaire [ICIQ]) and renal failure were recorded. All patients underwent ultrasound imaging of the bladder during their follow-up and on the last evaluation. Expanded Disability Status Scale (EDSS) was evaluated during neurologic follow-up. For each patient mean onset age of disease, mean onset age of micturation disorders, mean illness duration and mean urological follow-up duration were recorded. Urodynamic investigation was performed for all patients. Urodynamic assessment was carried out according to the International Continence Society (ICS) standards (detrusor overactivity, detrusor/sphincteric dyssynergia and low bladder compliance).

Results: Mean illness duration was 13.8 years (1-50). According to the history and clinical findings, 21 patients had primary-progressive (PPMS), 59 relapsing-remitting (RRMS) and 41 secondary-progressive multiple sclerosis (SPMS). Four patients have shown renal failure during their follow-up (3.3% - three men and one woman). Renal failure was associated with disease characteristic (SPMS - EDSS score >6.5), mean illness duration (30 years [12-48]) and low bladder compliance (17 [7-23]) (P=0.03; P=0.02; P=0.049).

Conclusion: Relationship between renal failure, disease characteristics and urodynamic findings was suggested in our study. More accurate follow-up might be used for SPMS (EDSS >6.5), longer mean illness duration (>30 years), and low bladder compliance (<30).