The following is the summary of “Risk factors for end stage renal disease in children with anorectal malformation and outcome comparison to children with isolated urological anomalies”  published in the December 2022 issue of Pediatric urology by Duci, et al.

The need for a kidney transplant (KT) due to end-stage renal disease (ESRD) is a leading cause of morbidity in patients with anorectal malformations (ARM). Unfortunately, there is a lack of data in the current literature that clearly defines the factors that increase the likelihood of ESRD and the outcomes of KT in patients with ARM. The goals of this research were to identify risk factors for end-stage renal disease (ESRD) in individuals with ARM and to determine whether or if the long-term result of KT in these patients varies from that seen in patients with purely urological abnormalities (UA).

The characteristics of ARM cases that progressed to ESRD and those that did not, as well as the features of the outcomes of MAR-KT and UA-KT, were compared using databases of ARM and KT patients treated at their facility between 2000 and 2016. There were 9 cases of end-stage renal disease (ESRD) cases among 117 people with ARM. It was universal that each ARM was quite intricate. There was a statistically significant increase in the prevalence of UA in ARM-KT patients compared to those with other types of ARM (100% vs. 52%). Among people with ARM, renal dysplasia was the most prevalent UA connected to KT. During the same time span, 23 patients received KT as a direct result of purely urological abnormalities (UA-KT group). The most common causes of UA in UA-KT patients were primary vesico-ureteral reflux (65.2% of cases) and posterior urethral valves (14% of cases) (table 2). Compared to UA-KT patients, ARM-KT patients were more likely to need pre-KT hemodialysis (50% vs. 8.7%, P=0.05) and aorto-caval anastomosis (75% vs. 30%, P=0.04). In addition, graft failure was more common in ARM-KT patients, and they required a second KT more often (50% vs. 8.6%, P=0.02).

Researchers have yet to learn of any other research that compares the risks and outcomes of KT between ARM patients. Hence this is a groundbreaking study. The proportion of ARM for which we found a need for KT, at 7%, is higher than that found elsewhere in the literature. Compared to vesico-ureteral reflux and posterior urethral valve in UA-KT, bilateral dysplasia, and cloacal deformity appear to be the primary cause of end-stage renal disease (ESRD) in ARM patients. Our data shows that KT is less successful in treating ARM than in treating pure UA. Kidney failure (KT) is more common in patients with complicated ARM because of renal dysplasia. Patients with ARM appear to be more at risk for graft failure.