ORIGINAL ARTICLE Urological anomalies and chronic kidney disease in children with anorectal malformations Indra Ganesan & Shunmugam Rajah Received: 18 December 2011 / Revised: 29 January 2012 / Accepted: 30 January 2012 / Published online: 3 March 2012 # IPNA 2012 Abstract Background This study aims to predict risk factors for uro- logical anomalies in children with anorectal malformations (ARM) and describes the clinical features of patients who have developed chronic kidney disease. Methods We retrospectively reviewed infants with ARM who received surgery and were followed at the Sabah Wom- en and Children’ s Hospital, Malaysia, from 1986 to 2010. Results One hundred and twenty-two children with anorec- tal malformations were studied, after excluding 24 children with incomplete data. Three factors were significant as predictors of the presence of a urological anomaly: high ARM lesion (OR 3.12, 95%CI 1.1–8.9), the presence of genital abnormality (OR 2.95, 95%CI 1.10–7.91) and cloa- cal anomaly in girls (OR 8.27, 95% CI 1.91–35.6). The most common anomalies were vesicoureteric reflux, single kid- ney and neurogenic bladder. Chronic kidney disease (CKD) was noted in 5.7%, in children who had recurrent urinary tract infections, neurogenic bladder or complex renal tract pathology; end-stage renal failure was seen in only 0.8% of children with ARM. Conclusion Urological anomalies were seen in 23% of patients, but the overall incidence of CKD and end-stage renal disease is low. Early identification of infants with ARM at risk of renal failure may be important for renal survival. Keywords Anorectal malformation . Urological anomaly . Chronic kidney disease . Children Introduction Anorectal malformation (ARM), a condition in which the anus fails to open at the perineum, occurs in 1 in 5,000 live births [1]. Genital and urological anomalies occur in about 25–50% of all patients with anorectal malformation [2] with the latter group at risk of renal failure. This study aims to characterise urinary tract abnormalities in patients with ano- rectal malformations and to predict risk factors for renal function deterioration. Materials and methods Retrospective chart analysis was performed on children with anorectal malformations followed at the Paediatric Surgery Clinic at Sabah Women and Children’ s Hospital (SWACH), Kota Kinabalu, Malaysia from 1986 to 2010. A standardised data form collected demographic and clinical information. Specifically, the type of ARM and associated anomalies were noted. Renal involvement was determined by urinary tract ultrasound, micturating cystourethrogram and renal biochemistry. Inclusion criteria were all infants with ano- rectal malformations who had surgical interventions and investigations performed at our centre. Patients who were followed at other centres were excluded, as clinical data and investigations were not readily available to us. I. Ganesan (*) Paediatric Nephrology Service, Department of Paediatrics, KK Women’ s and Children’ s Hospital, 100 Bukit Timah Road, Singapore 298090, Singapore e-mail: Indra.Ganesan@kkh.com.sg S. Rajah Department of Paediatric Surgery, Sabah Women and Children’ s Hospital, Kota Kinabalu, Malaysia Pediatr Nephrol (2012) 27:1125–1130 DOI 10.1007/s00467-012-2128-6