Renal Tubular Dysfunction After Urinary Diversion

Kristjánsson, A.; Grubb, Anders; Månsson, Wiking

doi:10.3109/00365599509180021

Cited by 18 publications

(8 citation statements)

References 18 publications

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“…The frequently noted DMSA changes did not seem to indicate severely impaired tubular function, however, since protein HC, a low molecular weight protein, filtered freely in glomeruli and reabsorbed in the proximal tubules, was normal in all except one, in which it was marginally elevated. This compares favourably with elevated levels in 36% of adults (23), and is perhaps due to better initial renal function in our patients; however, it might also be related to length of followup. Acidosis in one patient was not combined with impaired total renal function and was easily treated with bicarbonate.…”

Section: Discussionsupporting

confidence: 63%

Pediatric Urinary Tract Reconstruction Using Intestine

Kockum

1999

Scandinavian Journal of Urology and Nephrology

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Scand J Urol Nephrol 33: 53-56, 1999 Objective: To analyse the outcome of urinary tract reconstruction in children. Material and methods: Fifteen children with bladder exstrophy or neurogenic bladder, 4-18 years old, were followed in accordance with a predetermined program for bladder augmentation (13 pat) or continent urinary reservoir (2 pat). The follow-up time was 1.7-6.3 years, median 3.7 years. Results: All were dry, though one case had occasional leaks. Three bladder neck reconstructions, two artificial sphincters, one sling plasty and one fistula closure with subsequent bladder neck injection were required. Bladder volumes were adequate for age at low pressures. Reflux resolved in 12/13 ureters. A boy with preoperative renal insufficiency was transplanted. Total renal function remained otherwise stable despite acidosis in one case and some glomerular impairment in all. Progressive parenchymal lesions were seen in combination with abundant mucus, infections and calculi only. Growth and bowel function was unaffected. Bone mineral density showed overall increase; some low values were not consistent between investigations. Conclusions: Urinary tract reconstruction in children results in continence and regression of reflux. Growth, bone mineralization and renal function are unimpaired during the first years, but irrigation of the bladder is essential to minimize the risk of urinary tract infection. However, glomerular function might be affected and the possible risk of metabolic complications in later life can only be determined by continuous close monitoring over an extended period of time. Abbreviations: voiding cystourethrogram (VCUG), dimercapto-succinic acid (DMSA), Chrome 51 -Ethylenediaminetetraacetic acid (Cr-EDTA), single photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon xray absorption (DEXA), glomerular filtration rate (GFR), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermittent catheterization (CIC) and subureteral teflon injection (STING).

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Section: Discussionsupporting

confidence: 63%

Pediatric Urinary Tract Reconstruction Using Intestine

Kockum

1999

Scandinavian Journal of Urology and Nephrology

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“…Kristjansson et al. [14] showed that the urinary protein HC may be a suitable marker for detecting early renal impairment. The present study started in 1983 and did not include an assessment of renal tubular function.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with damage from post-renal causes, which would include re¯ux and infection in patients with bowel reservoirs, it is known that tubular damage precedes glomerular damage. Kristjansson et al [14] showed that the urinary protein HC may be a suitable marker for detecting early renal impairment. The present study started in 1983 and did not include an assessment of renal tubular function.…”

Section: Discussionmentioning

confidence: 99%

The effect of intestinal urinary reservoirs on renal function: a 10‐year follow‐up

2000

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Objective To study the effect of the storage of urine in intestinal reservoirs on long-term renal function and the possible causes of deterioration. Patients and methods Eighty-seven patients (aged 4±35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular ®ltration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51 Cr-ethylenediamine tetra-acetic acid. Patients with a decline in GFR of >5% were investigated to identify the cause. Results Of 58 patients with a follow-up of o10 years, 53were evaluable, four having been lost to follow-up and one refusing to accept the protocol. In these 53 patients, the mean (SD) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m 2 (P=0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by o 20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (®ve), uretero-ileal stenosis (one), a high-pressure reservoir (one) and uncertain causes (three). Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, < 20% of patients had some deterioration in renal function during the 10-year follow-up, usually from identi®able and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function.Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed.

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“…The appearance of certain low molecular weight proteins in the urine, which are filtered in the glomeruli and then almost totally reabsorbed in the proximal tubuli, indicates proximal tubular dysfunction. Protein HC (α1‐microglobulin) has been suggested as a suitable marker for detecting early renal impairment after urinary diversion [ 24].…”

Section: Clinical Studies On Renal Function — Methodologymentioning

confidence: 99%