Measurement and Estimation of Glomerular Filtration Rate in Children With Neurogenic Bladder: A Prospective Study

Zhou, Guanglun; Jiang, Man; Liu, Xiaodong; Ye, Mei; Li, Fangyuan; Li, Shoulin

doi:10.1016/j.urology.2022.08.004

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…The eGFR calculated through the CKiD-Cr (Schwartz bedside) formula is the common method used to assess kidney function in children. However, the reduced muscle mass in patients with NB turns creatinine into a less accurate marker, as reported in previous studies [5,15,16,23,26,27] .…”

Section: Discussionmentioning

confidence: 62%

“…On the other hand, although combined Cr-and CysC-based equations demonstrated better accuracy in estimating GFR in children with CKD [28,19] , they may have worse performance than CysC-based formulas in NB pediatric patients [15,16,29] . Additionally, creatinine-based equations used to estimate GFR require an accurate height measurement, which can be di cult to obtain in non-ambulatory NB patients with paretic, underdeveloped and often spastic lower limbs [13] .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is of paramount importance to achieve an early diagnosis and to better identify risk factors, in order to prevent the kidney disease progression and preserving lifetime kidney function. Thus, accurately measuring kidney function is crucial to identify patients in early stages of kidney dysfunction and closely monitor its progression [6,7,[14][15][16][17] . The evaluation of glomerular ltration rate (GFR) is essential to assess kidney function.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with NB, with reduced muscle mass, the eGFR determination with creatinine based-equations may have lower sensitivity and overestimate eGFR, suggesting they may not be reliable [1,6,15,16,23] . Due to the risk of CKD progression, it is important to nd more sensitive methods for evaluating eGFR in early stages and CysC-based formulas may be more accurate in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies report an important variability between eGFR calculated by Cr and CysC-based formulas in patients with spina bi da or NB, both in adults and children. Furthermore, in those studies, the eGFR based on CysC upgraded CKD to a more advanced stage [1,5,15,16,21,23,24] . However, comparative studies of eGFR between patients with NB and different levels of neurological damage, and consequently with different degrees of muscle mass reduction, are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Estimating Glomerular Filtration Rate in Pediatric Patients with Neurogenic Bladder: a comparison between Creatinine- and Cystatine C-equations

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et al. 2023

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Purpose: Patients with neurogenic bladder (NB) have higher risk of developing chronic kidney disease (CKD). Due to their lower muscle mass, the estimated glomerular filtration rate (eGFR) using creatinine (Cr) may be overestimated and delay the diagnosis of renal failure. The study compare eGFR calculated by different formulas based on creatinine and/or cystatin C (CysC) in children with NB, and the differences between patients with lower muscle mass (underdeveloped lower limbs) and with independent gait (less muscle depletion). Methods: The eGFR was calculated in all pediatric patients with NB and CKD stage 1 and 2, using different formulas: CKiD-Cr, CKiD-CysC, CKiD combined-Cr/CysC, Zappitelli-CysC and Zappitelli combined-Cr/CysC. Results: Forty-seven patients were evaluated, 74.5% in CKD stage 1, with median age of 14.1 years, 59.6% had lipo/myelomeningocele. When compared with CKiD-Cr, CysC-based formulas showed lower eGFR (p<0.05), (CKiD-CysC (p<0.001), Zappitelli-CysC (p<0.001), CKiD -Cr/CysC (p<0.001) and Zappitelli combined-Cr/CysC (p<0.05)). When CKiD-CysC was used, 68% of patients moved to a more advanced CKD stage. In patients without independent gait, with lower muscle mass (55.3%), the median eGFR using CKiD-Cr and CKiD combined-Cr/CysC were higher (p<0.05). No differences were found between the two groups using the others CysC-based formulas. Conclusion: In patients with NB and poor muscle mass, CKiD-Cr formula may overestimate renal function. CysC-based formulas seem more reliable in these patients, especially in those with greater muscular atrophy.

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