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Is baseline routine renal ultrasound indicated for all MS patients?
  1. Igor B Títoff,
  2. Victoria Titoff,
  3. Thomas F Scott
  1. Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Thomas F Scott, Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA; thomas.scott{at}ahn.org

Abstract

Background Most patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.

Methods Prospectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.

Results 872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.

Conclusion The minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.

  • routine renal ultrasound
  • multiple sclerosis
  • neurogenic bladder
  • urological screening
  • upper urinary tract dysfunction
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Footnotes

  • Presented at This work was previously presented at the 70th Annual Meeting of the American Academy of Neurology: Los Angeles, California. April 2018.

  • Contributors TFS, IBT and VT contributed to the design of the study, collection of the data, analysis of the data and the production of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TFS has received payments for research activities, advisory boards, promotional speaking and consulting for Genentech, Teva Neuroscience, Biogen, Novartis and Genzyme.

  • Patient consent for publication Not required.

  • Ethics approval Our central IRB at Allegheny General Hospital approved this research (RC # 6238-AGH).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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