Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation

Muller, Thomas E.; Arbeiter, Klaus; Aufricht, Christoph

doi:10.1097/00042307-200211000-00006

Cited by 103 publications

(79 citation statements)

References 41 publications

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“…Decreased bladder compliance, detrusor overactivity, bladder trabeculation and VUR have been found to be correlated with the cause of febrile UTI in myelodysplastic children [15] . Prevention of UTI besides VUR is also important as acute pyelonephritis may contribute to the progressive scar formation [1] . UTI has been accepted as a definite risk factor for renal scarring [2] .…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Renal Scar Development in Children with Spina Bifida

et al. 2007

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Background/Aims: Prevention of renal scarring is the main therapeutic goal in children with spina bifida. We aimed to determine factors affecting renal scar development in these patients. Materials and Methods: Records of 312 children admitted between 1994 and 2005 with spina bifida were reviewed. Age on admission, gender, presence of previous febrile urinary tract infections (UTIs), vesicoureteral reflux (VUR), and initial urodynamic findings were noted. Patients were grouped regarding presence/absence of renal scars on DMSA scans. χ² and Student’s t tests were used for statistical evaluation. Results: Seventy-two patients had renal scars on admission. Mean age was 4.62 ± 4.59 years for patients without renal scars and 6.35 ± 4.9 years for patients with scars. Male/female ratio was 1:1 in the scarless group and 1:2 in the group with scars. Previous febrile UTI was present in 11 of 240 scarless patients in contrast to 7 out of 72 patients in the scar group (p > 0.05). VUR was present in only 16.3% of cases without scars, whereas 36.1% of patients in the scar group had VUR. Detrusor overactivity and detrusor sphincter dyssynergia were observed in 67.1% of scarred patients, whereas this figure was 42.4% in the scarless group. The comparison of age on admission, gender, detrusor overactivity, and detrusor sphincter dyssynergia revealed significant differences between patients with and without renal scars. Conclusions: Late referral, female gender, overactive detrusor, and detrusor sphincter dyssynergia have detrimental effects on renal parenchymal function in spina bifida patients. Patient selection for aggressive treatment using these features may prevent renal parenchymal deterioration.

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Section: Discussionmentioning

confidence: 99%

“…Chronic renal failure and its complications are among the most frequent cause of morbidity and mortality in these patients [1] . Aggressive surgical measures are mandatory such as augmentation cystoplasties when medical treatment modalities fail to prevent scar formation.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Renal Scar Development in Children with Spina Bifida

et al. 2007

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Introduction: Myelomeningocele (MMC) is a congenital central nervous system malformation caused by a failure of the neurulation process in early pregnancy. Patients with MMC present many abnormalities and the nervous, skeletal and urinary systems are the most affected. The aim of this study was to clinically evaluate patients with MMC, estimate renal and lower urinary tract (LUT) function and to ascertain whether urodynamic findings can predict the deterioration of urinary tract function. Materials and Methods: Medical records of 112 patients were gathered from a database and evaluated retrospectively. The data included age, sex, BMI Z-score WHO, physical activity, urodynamic parameters and diagnosis and renal function. Results: A total of 112 patients with MMC were enrolled in the study. There were no differences in age, sex, BMI Z-score WHO, physical activity, renal function and urodynamic findings (apart from cystometric capacity) between boys and girls. Detrusor overactivity was the most frequent urodynamic diagnosis in all groups of physical activity, level of lesion and in catheterized and non-catheterized children. The correlations between urodynamic findings and renal function tests were found. Conclusions: Patients with neurogenic bladder after MMC most often present detrusor overactivity. LUT function is disturbed in all MMC patients independent of lesion level and physical activity.

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“…Although the viability and safety of PD in spina bifida patients with a VPS have been a matter of concern [5,6] , we could find only four references on concomitant VPS and PD in the literature [6][7][8][9] . Some authors consider the presence of a VPS a relative contraindication to PD because of the potential risks of shunt-induced peritoneal damage and ascending infection through the shunt [10,12] . However, based on a review of the literature, Warady et al [6] , Mül-ler et al [12] and Grünberg et al [8,9] concluded that PD is not an absolute contraindication in patients with a functioning VPS and hence it should not be precluded.…”

Section: Peritoneal Dialysis With Ventriculoperitoneal Shuntmentioning

confidence: 99%

Peritoneal Dialysis in a Patient with Neurogenic Bladder and Chronic Kidney Disease with Ventriculoperitoneal Shunt

Prabahar

Sivakumar²,

Chandrasekaran³

et al. 2008

Blood Purif

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Long-term dialysis in children with multiple handicaps has become easier with the advent of continuous ambulatory peritoneal dialysis (PD). Due to the widespread use of PD and the long survival of patients with spina bifida, an increasing number of patients with spina bifida are on PD. The viability and safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) have been a matter of concern. Some authors consider the presence of a VPS a relative contraindication for PD, but more recent reports suggest that PD under close monitoring is not contraindicated. We report a 17-year-old girl born with meningomyelocele, hydrocephalus and neurogenic bladder who was maintained on VPS. She reached end-stage renal failure 17 years later and was put on PD based on family and patient preference. She had an uneventful course in the initial 9 months, but later developed fungal peritonitis which was successfully managed with catheter withdrawal and an intravenous antifungal agent (amphotercin 0.75 mg/kg). Simultaneous ventricle-aspirated cerebrospinal fluid was sterile. To our knowledge, this is the first report of fungal infection in such a patient. Although we share the view that PD is not an absolute contraindication in patients with a functioning VPS, its likely complications, especially infectious complications in developing countries, should be kept in mind before initiating PD in such patients.

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Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation

Cited by 103 publications

References 41 publications

Factors Affecting Renal Scar Development in Children with Spina Bifida

Factors Affecting Renal Scar Development in Children with Spina Bifida

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

Peritoneal Dialysis in a Patient with Neurogenic Bladder and Chronic Kidney Disease with Ventriculoperitoneal Shunt

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