Study of serum and urinary markers of the reninangiotensin-aldosterone system in myelomeningocele patients with renal injury detected by DMSA

Amaral, Cássia Maria Carvalho Abrantes do; Casarini, Dulce Elena; Andrade, Maria Cristina de; Cruz, Marcela Leal da; Macedo, António

doi:10.1590/s1677-5538.ibju.2019.0797

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Of the ones with late initiation of treatment, 42% developed renal disease (Sager et al, 2020, data not published). Despite advances in the understanding of Renin--Angiotensin-Aldosterone System (RAAS) as a participant in the mechanism of renal injury, the analysis of its serum (ACE and ACE 2) and urinary (urinary ACE) markers was not significant in patients with MMC with renal injury previously detected by renal DMSA scintigraphy (107).…”

Section: Renal Function In Pediatric Neurogenic Bladdermentioning

confidence: 99%

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Sager¹,

Barroso

Bastos

et al. 2022

Int. braz j urol.

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Introduction: Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifi da, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classifi cation of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the fi rst days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to fi rst-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.

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Section: Renal Function In Pediatric Neurogenic Bladdermentioning

confidence: 99%

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Sager¹,

Barroso

Bastos

et al. 2022

Int. braz j urol.

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“…There was a significant association between the presence of renal parenchyma changes and increased SCr. Similarly, Ataei et al [ 36 ] reported a significant correlation between renal parenchyma changes and increased SCr, but Amaral et al [ 37 ] did not report any. This discrepancy may be due to the unbalanced alterations in muscle mass and tubular secretion and their effects on the SCr levels [ 38 ].…”

Section: Discussionmentioning

confidence: 98%

Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis

et al. 2021

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Background The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. Methods A retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated. Results 92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI. Conclusions Low BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.

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“…The knowledge about myelomeningocele and urological presentation and outcome in ongoing advocates early clean intermittent catheterization (CIC) and antimuscarinic drugs should be indicated upon results of urodynamic studies. (13) There are still no serum indicators that allow recording renal damage before the lesion established on DMSA scintigraphy (14). Reconstructive surgery (such as enterocystoplasty) was indicated for patients who were refractory to clinical treatment.…”

Section: Introductionmentioning

confidence: 99%

In utero myelomeningocele repair and high-risk bladder pattern. a prospective study

Macedo

Ottoni²,

Moron

et al. 2022

Int. braz j urol.

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Objectives: High-risk bladder pattern can be defined by Urodynamic Evaluation (UE) as overactive bladder with detrusor leak point pressure higher than 40 cmH2O and/ or higher filling pressures also above 40 cmH2O. We wanted to evaluate response to treatment in myelomeningocele patients operated in utero in this subgroup. Patients and Methods: From our prospective cohort of in utero MMC we have identified patients in the high-risk group. Treatment consisted of anticholinergics (Oxybutynin 0.2 mg/Kg) 2 or 3 times daily in association with CIC. At every UE, patients were reclassified in high-risk or low-risk patterns. Patients not responding were proposed bladder reconstruction or diversion according to age. Results: Between 2011 to 2020, we have been following 121 patients and 60 (49.6%) of them were initially categorized as high-risk. The initial UE was performed at a mean age of 7.9 months and detrusor overactivity was found in 83.3% (mean maximum pressure of 76.5cmH20). When evaluating patients with 2 or more UE, we identified 44 patients (follow-up: 36.8months). It was observed in the group of patients who underwent 2 to 5 UE, that response to treatment was validated by the finding of 40% of low-risk bladder patterns in the second UE and between 62% to 64% in the third to the fifth UE. The incidence of surgery was 13.3%. Conclusions: Early urological treatment of high-risk bladder pattern was effective in approximately 60%. We reinforce the need to correctly treat every patient with myelomeningocele, in accordance with UE, whether undergoing in utero or postnatal treatment.

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Study of serum and urinary markers of the reninangiotensin-aldosterone system in myelomeningocele patients with renal injury detected by DMSA

Cited by 4 publications

References 28 publications

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis

In utero myelomeningocele repair and high-risk bladder pattern. a prospective study

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