Renal function in children with congenital neurogenic bladder

Abstract

AIMS:Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder.METHODS:We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5% significance level.RESULTS:The mean age at presentation was 4.2 ± 3.5 years. Myelomeningocele was the most frequent etiology (71.4%). Recurrent urinary tract infection was the reason for referral in 82.8% of the patients. Recurrent urinary tract infections were diagnosed in 84.5% of the patients initially; 83.7% of those patients experienced improvement during follow‐up. The initial mean glomerular filtration rate was 146.7 ± 70.1 mL/1.73 m2/min, and the final mean was 193.6 ± 93.6 mL/1.73 m2/min, p = 0.0004. Microalbuminuria was diagnosed in 54.1% of the patients initially and in 69% in the final evaluation. Metabolic acidosis was present in 19% of the patients initially and in 32.8% in the final assessment.CONCLUSIONS:Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management.

Urodynamic Findings and Renal Function in Children with Neurogenic Bladder after Myelomeningocele

“…As stated by Müller et al [29], renal damage is the most prevalent cause of morbidity and mortality in spina bifida adults and even in children as 30-40% exhibit evidence of renal damage. Renal function in children with MMC was also described by Olandoski et al [30], who revealed that children with congenital neurogenic bladder presented renal damage in >50% of the studied cases and were referred for renal evaluation too late, that is, at a mean age of 4.2 years. Loss of renal function is a painless, long-lasting process and all the laboratory findings suggesting deterioration of renal function are detected at a time when this process is irreparable.…”

Clinical characteristics of patients with neurogenic bladder due to myelomeningocele – Eighteen-year retrospective study; University Children's Hospital, Bialystok, Poland

“…In other studies quite a big number of MMC patients did not see a nephrologist up to the age of 4.2 years and stayed under the care of pediatricians and urologists [24]. We have been carrying out the diagnostic program for many years in cooperation with other specialists, realizing that MMC patients are in the risks group of chronic renal diseases.…”

Impacto do tratamento urológico na qualidade de vida de crianças com mielomeningocele e na sobrecarga de seus cuidadores

“…Qualquer alteração nas estruturas neurológicas envolvidas na regulação do ciclo da micção pode causar a disfunção neurológica do trato urinário inferior (DNTUI), descrita por disfunção na complexa inervação vésico-esfincteriana e da musculatura perineal, ocasionando falta total de controle e sensibilidade ou funcionamento dissinérgico da bexiga urinária. A MMC é a principal causa da ocorrência de DNTUI na infância 3,4 .…”