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International Urology and Nephrology

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01.06.2012 | Nephrology – Review

Prevention of chronic kidney disease in spina bifida

verfasst von: Guido Filler, Mireille Gharib, Shelley Casier, Petra Lödige, Jochen H. H. Ehrich, Sumit Dave

Erschienen in: International Urology and Nephrology | Ausgabe 3/2012

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Abstract

Objective

The prevalence of progressive chronic kidney disease (CKD) in children and adults with spina bifida is considerable, rising, and entirely preventable.

Removing the cause: prevention of spina bifida

The best prevention of CKD in spina bifida is prevention of spina bifida itself through strategies that include folate supplementation, ideally before pregnancy.

The cause of CKD

Dysfunctional bladder outlet causes febrile Urinary Tract Infections (UTI), even with clean intermittent catheterization (CIC), and subsequent renal scarring. The development of secondary vesicoureteric reflux (VUR) increases the risk of renal scarring and CKD.

Finding the ideal marker for measurement of renal function in spina bifida

Creatinine-based methods are insensitive because of low muscle mass and underdeveloped musculature in the legs. Only Cystatin C–based eGFR can reliably assess global renal function in these patients. However, unilateral renal damage requires nuclear medicine scans, such as ^99mTc DMSA.

(Video)Urodynamics studies (UDS)

Early treatment is recommended based on UDS with anticholinergics, CIC, and antibiotic prophylaxis when indicated. Overnight catheter drainage, Botox, and eventually augmentation cystoplasty are required for poorly compliant bladders. A continent child or one rendered continent following surgery is at a higher risk of renal damage.

Conclusion

A multidisciplinary approach is required to reduce the burden of CKD in patients with spina bifida. The right tools have to be utilized to monitor these patients, particularly if recurrent UTIs occur. Cystatin C eGFR is preferred for monitoring renal damage in these patients, and ^99mTc DMSA scans have to be used to detect unilateral renal scarring.

Mulinare J, Erickson D (1997) Prevention of neural tube defects. Teratology 56:17–18PubMedCrossRef

Muralikrishna GS, Rodger RS, Macdougall AI, Boulton-Jones JM, Allison ME, Kyle KF, Junor BJ, Briggs JD (1989) Renal replacement treatment in patients with spina bifida or spinal cord injury. BMJ 299:1506PubMedCrossRef

Lapides J, Diokno AC, Silber SJ, Lowe BS (1971) Clean, intermittent self-catheterization in the treatment of urinary tract disease. Trans Am Assoc Genitourin Surg 63:92–96PubMed

Edelstein RA, Bauer SB, Kelly MD, Darbey MM, Peters CA, Atala A, Mandell J, Colodny AH, Retik AB (1995) The long-term urological response of neonates with myelodysplasia treated proactively with intermittent catheterization and anticholinergic therapy. J Urol 154:1500–1504PubMedCrossRef

Lee CY, Lee CY (2010) Long-Term Renal Outcome in Patients with Lumbar Meningomyelocele. Abstract# 864. Pediatr Nephrol 25:1967

Muller F, O’Rahilly R (2004) The primitive streak, the caudal eminence and related structures in staged human embryos. Cells Tissues Organs 177:2PubMedCrossRef

Alvarez IS, Schoenwolf GC (1992) Expansion of surface epithelium provides the major extrinsic force for bending of the neural plate. J Exp Zool 261:340PubMedCrossRef

Muller F, O’Rahilly R (1987) The development of the human brain, the closure of the caudal neuropore, and the beginning of secondary neurulation at stage 12. Anat Embryol 176:413PubMedCrossRef

Juranek J, Salman MS (2010) Anomalous development of brain structure and function in spina bifida myelomeningocele. Dev Disabil Res Rev 16(1):23–30PubMedCrossRef

10.

Frey L, Hauser WA (2003) Epidemiology of neural tube defects. Epilepsia (suppl 44) 3:4

11.

MacHenry JCRM, Nevin NC, Merrett JD (1979) Comparison of central nervous system malformations in spontaneous abortions in Northern Ireland and south-east England. Br Med J 1:1395–1397PubMedCrossRef

12.

Frey L, Hauser WA (2003) Epidemiology of neural tube defects. Epilepsia 44(Suppl 3):4–13PubMedCrossRef

13.

Nicolaides KH, Campbell S, Gabbe SG, Guidetti R (1986) Ultrasound screening for spina bifida: cranial and cerebellar signs. Lancet 2:72PubMedCrossRef

14.

Wald N, Cuckle H, Nanchahal K (1989) Amniotic fluid acetylcholinesterase measurement in the prenatal diagnosis of open neural tube defects. Prenat Diagn 9:813PubMedCrossRef

15.

Berry RJ, Li Z, Erickson JD et al (1999) Prevention of neural-tube defects with folic acid in China. N Engl J Med 341:1485PubMedCrossRef

16.

Goh YI, Bollano E, Einarson TR, Koren G (2006) Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can 28:680PubMed

17.

Shaw GM, Schaffer D, Velie EM et al (1995) Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects. Epidemiology 6:219PubMedCrossRef

18.

Antal R, Siffel C, Czeizel E (1996) Prevention of anencephaly-spina bifida. Orv Hetil 137:100PubMed

19.

Oakley GP Jr, Erickson JD, James LM, Mulinare J, Cordero JF (1994) Prevention of folic acid-preventable spina bifida and anencephaly. Ciba Found Symp 181:212–223 Discussion 223–231PubMed

20.

Hernandez-Diaz S, Werler MM, Walker AM, Mitchell AA (2000) Folic acid antagonists during pregnancy and the risk of birth defects. N Engl J Med 343:1608PubMedCrossRef

21.

Blencowe H, Cousens S, Modell B, Lawn J (2010) Folic acid to reduce neonatal mortality from neural tube disorders. Int J Epidemiol 39(Suppl 1):i110–i121PubMedCrossRef

22.

Alasfoor D, Elsayed MK, Mohammed AJ (2010) Spina bifida and birth outcome before and after fortification of flour with iron and folic acid in Oman. East Mediterr Health J 16:533–538PubMed

23.

De Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B et al (2007) Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med 357:135–142PubMedCrossRef

24.

de Jong TP, Chrzan R, Klijn AJ, Dik P (2008) Treatment of the neurogenic bladder in spina bifida. Pediatr Nephrol 23:889–896PubMedCrossRef

25.

Almodhen F, Capolicchio JP, Jednak R, El Sherbiny M (2007) Postpubertal urodynamic and upper urinary tract changes in children with conservatively treated myelomeningocele. J Urol 178(4 Pt 1):1479–1482PubMedCrossRef

26.

MacLellan DL (2009) Management of pediatric neurogenic bladder. Curr Opin Urol 19(4):407–411PubMedCrossRef

27.

Kaefer M, Pabby A, Kelly M et al (1999) Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele. J Urol 162:1068PubMedCrossRef

28.

Müller T, Arbeiter K, Aufricht C (2002) Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation. Curr Opin Urol 12(6):479–484PubMedCrossRef

29.

Panicker JN, de Sèze M, Fowler CJ (2010) Rehabilitation in practice: neurogenic lower urinary tract dysfunction and its management. Clin Rehabil 24:579–589PubMedCrossRef

30.

Dwoskin JY, Perlmutter AD (1973) Vesticoureteric reflux in children: a computerized review. J Urol 109:888–890PubMed

31.

Jafri RA et al (1988) 99Tcm-MAG-3: a comparison with I-123 and I-131 orthoidohippurate in patients with renal disorder. J Nucl Med 19:994–1000

32.

Ottolini MC, Shaer CM, Rushton HG, Majd M, Gonzales EC, Patel KM (1995) Relationship of asymptomatic bacteriuria and renal scarring in children with neuropathic bladders who are practicing clean intermittent catheterization. J Pediatr 127:368–372PubMedCrossRef

33.

Schlager TA, Clark M, Anderson S (2001) Effect of a single use sterile catheter for each void on the frequency of bacteriuria in children with neurgenic bladder on intermittent catheterization for bladder emptying. Pediatrics 108:e71PubMedCrossRef

34.

Joseph DB, Bauer SB, Colodny AH, Mandell J, Retik AB (1989) Clean intermittent catheterization in infants with neurogenic bladder. Pediatrics 84:78PubMed

35.

Galloway A, Green HT, Windsor JJ, Menon KK, Gardner BP, Krishnan KR (1986) Serial concentrations of C-reactive protein as an indicator of urinary tract infection in patients with spinal injury. J Clin Pathol 39:851–855PubMedCrossRef

36.

Muller T, Arbeiter K, Aufricht C (2002) Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation. Curr Opin 12:479

37.

van Gool JD, Dik P, de Jong TP (2001) Bladder-sphincter dysfunction in myelomeningocele. Eur J Pediatr 160(7):414–420PubMedCrossRef

38.

Bauer SB, Hallet M, Khoshbin S, Leowitz RL, Winston KR, Gibson S, Colodny AH, Retik AB (1984) Predictive value of urodynamic evaluation in newnborns with myerlodysplasia. JAMA 252:650PubMedCrossRef

39.

Tepmongkol S, Chotipanich C, Sirisalipoch S, Chaiwatanarat T, Vilaichon AO, Wattana D (2002) Relationship between vesicoureteral reflux and renal cortical scar development in Thai children: the significance of renal cortical scintigraphy and direct radionuclide cystography. J Med Assoc Thai 85(Suppl 1):S203–S209PubMed

40.

Lee JH, Son CH, Lee MS, Park YS (2006) Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 21:1281–1284PubMedCrossRef

41.

Morgan C, Senthilselvan FB, Hoskinson M, Gowrishankar M (2008) Correlation between cystatin C- and renal scan- determined glomerular filtration rate in children with spina bifida. Pediatr Nephrol 23:329–332PubMedCrossRef

42.

Rahn KH, Heidenreich S, Bruckner D (1999) How to assess glomerular function and damage in humans. J Hypertens 17:309PubMedCrossRef

43.

Schwartz GJ, Furth SL (2007) Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol 22:1839–1848PubMedCrossRef

44.

Filler G, Browne R, Seikaly MG (2003) Glomerular filtration rate as a putative ‘surrogate end-point’ for renal transplant clinical trials in children. Pediatr Transplant 7:18–24PubMedCrossRef

45.

Stevens LA, Levey AS (2005) Measurement of kidney function. In: Singh AK (ed) Medical clinics of North America. W.B. Saunders, Philadelphia, p 457

46.

Schwartz GJ, Haycock GB, Edelman CM, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed

47.

Sharma AP, Filler G (2009) Monitoring kidney function and renal disease in children after transplant. Paediatr Health 3:155–163CrossRef

48.

Levey AS (1990) Measurement of renal function in chronic renal disease. Kidney Int 38:167PubMedCrossRef

49.

Doolan PD, Alpen EL, Theil GB (1962) A clinical appraisal of the plasma concentration and endogenous clearance of creatinine. Am J Med 32:65PubMedCrossRef

50.

Kim KE, Onesti G, Ramirez O, Brest AN (1969) Creatinine clearance in renal disease. Br Med J 4:11PubMedCrossRef

51.

Petri M, Bochenstedt L, Colman J et al (1988) Serial assessment of glomerular filtration rate in lupus nephropathy. Kidney Int 34:832PubMedCrossRef

52.

Pham-Huy A, Leonard M, Lepage N, Halton J, Filler G (2003) Measuring glomerular filtration rate with cystatin C and beta-trace protein in children with spina bifida. J Urol 169:2312–2315PubMedCrossRef

53.

Filler G, Bokenkamp A, Hofmann W, Le Bricon T, Martinez-Bru C, Grubb A (2005) Cystatin C as a marker of GFR- history, indications, and future research. Clin Biochem 38:1–8PubMedCrossRef

54.

Jung P (1987) Low molecular mass proteins in serum and their relationship to the glomerular filtration rate. Nephron 47:160–168PubMedCrossRef

55.

Grubb A, Simonsen O, Sturfelt G, Truedsson L, Thysell H (1985) Serum concentration of cystatin C, factor D and b2-microglobulin as a measure of glomerular filtration rate. Acta Med Scand 218:499–503PubMedCrossRef

56.

Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Brodehl J (1998) Reference values for cystatin C serum concentrations in children. Pediatr Nephrol 12:125–129PubMedCrossRef

57.

Randers E, Krue S, Erlandsen EJ, Danielsen H, Hansen LG (1999) Reference interval for serum cystatin C in children. Clin Chem 45:1856–1858PubMed

58.

Norlund L, Fex G, Lanke J et al (1997) Reference intervals for the glomerular filtration rate and cell proliferation markers: serum cystatin C and serum b2-microglobulin/cystatin C-ratio. Scand J Clin Lab Invest 57:463–470PubMedCrossRef

59.

Harmoinen A, Ylinen E, Ala-Houhala M, Janas M, Kaila M, Kouri T (2000) Reference intervals for cystatin C in pre- and full-term infants and children. Pediatr Nephrol 15:105–108PubMedCrossRef

60.

Fischbach M, Graff V, Terzic J, Bergere V, Oudet M, Hamel G (2002) Impact of age on reference values for serum concentration of cystatin C in children. Pediatr Nephrol 17:104–106PubMedCrossRef

61.

Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Brodehl J (1998) Reference values for cystatin C serum concentrations in children. Pediatr Nephrol 12:125–129PubMedCrossRef

62.

Vinge E, Lindergard B, Nilsson-Ehle P, Grubb A (1999) Relationships among serum cystatin C, serum creatinine, lean tissue mass and glomerular filtration rate in healthy adults. Scand J Clin Lab Invest 59:587–592PubMedCrossRef

63.

Woitas RP, Stoffel-Wagner B, Flommersfeld S et al (2000) Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis. Clin Chem 46:712–715PubMed

64.

Thomassen SA, Johannesen IL, Erlandsen EJ, Abrahamsen J, Randers E (2002) Serum cystatin C as a marker of the renal function in patients with spinal cord injury. Spinal Cord 40:524–528PubMedCrossRef

65.

Abrahamsson K, Jodal U, Sixt R, Olsson I, Sillen U (2008) Estimation of renal function in children and adolescents with spinal dysraphism. J Urol 179:2407–2409PubMedCrossRef

66.

Ozel SK, Dokumcu Z, Akyildiz C, Avanoglu A, Ulman I (2007) Factors affecting renal scar development in children with spina bifida. Urol Int 79:133–136PubMedCrossRef

67.

Dik P, Klijn AJ, van Gool JD, van Steenwijk CC, de Jong TP (2006) Early start to therapy preserves kidney function in spina bifida patients. Eur Urol 49:908–913PubMedCrossRef

68.

Coulthard MG, Verber I, Jani JC, Lawson GR, Stuart CA, Sharma V, Lamb WH, Keir MJ (2009) Can prompt treatment of childhood UTI prevent kidney scarring? Pediatr Nephrol 24:2059–2063PubMedCrossRef

69.

Dawrant MJ, Mohanan N, Puri P (2006) Endoscopic treatment for high grade vesicoureteral reflux in infants. J Urol 176(4 Pt 2):1847–1850PubMedCrossRef

70.

Montini G, Hewitt I (2009) Urinary tract infections: to prophylaxis or not to prophylaxis? Pediatr Nephrol 24:1605–1609PubMedCrossRef

71.

Ziessman HA, Majd M (2009) Importance of methodology on (99m)technetium dimercapto-succinic acid scintigraphic image quality: imaging pilot study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) multicenter investigation. J Urol 182:272–279PubMedCrossRef

72.

Brandström P, Nevéus T, Sixt R, Stokland E, Jodal U, Hansson S (2010) The Swedish reflux trial in children: IV. Renal damage. J Urol 184:292–297PubMedCrossRef

73.

Shiroyanagi Y, Suzuki M, Matsuno D, Yamazaki Y (2009) The significance of 99mtechnetium dimercapto-succinic acid renal scan in children with spina bifida during long-term followup. J Urol 181:2262PubMedCrossRef

74.

Leonardo CR, Filgueiras MF, Vasconcelos MM, Vasconcelos R, Marino VP, Pires C, Pereira AC, Reis F, Oliveira EA, Lima EM (2007) Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction. Pediatr Nephrol 22(11):1891–1896PubMedCrossRef

75.

DeLair SM, Eandi J, White MJ, Nguyen T, Stone AR, Kurzrock EA (2007) Renal cortical deterioration in children with spinal dysraphism: analysis of risk factors. J Spinal Cord Med 30:30

76.

McGuire EJ, Woodside JR, Borden TA, Weiss RM (1981) Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 126(2):205–209PubMed

77.

Cho SY, Yi JS, Oh SJ (2009) The clinical significance of poor bladder compliance. Neurourol Urodyn 28:1010–1014PubMedCrossRef

78.

Khoury AE, Dave S, Peralta-Del Valle MH, Braga LH, Lorenzo AJ, Bägli D (2008) Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder. BJU Int 101:223–226PubMed

79.

Zermann DH, Löffler U, Reichelt O, Wunderlich H, Wilhelm S, Schubert J (2003) Bladder dysfunction and end stage renal disease. Int Urol Nephrol 35:93–97PubMedCrossRef

80.

Nguyen MT, Pavlock CL, Zderic SA, Carr MC, Canning DA (2005) Overnight catheter drainage in children with poorly compliant bladders improves post-obstructive diuresis and urinary incontinence. J Urol 174(4 Pt 2):1633–1636 discussion 1636PubMedCrossRef

81.

Gamé X, Mouracade P, Chartier-Kastler E, Viehweger E, Moog R, Amarenco G, Denys P, De Seze M, Haab F, Karsenty G, Kerdraon J, Perrouin-Verbe B, Ruffion A, Soler JM, Saussine C (2009) Botulinum toxin-A (Botox) intradetrusor injections in children with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. J Pediatr Urol 5(3):156–164PubMedCrossRef

82.

Duel BP, Gonzalez R, Barthold JS (1998) Alternative techniques for augmentation cystoplasty. J Urol 159:998–1005PubMedCrossRef

83.

Buffa P, Torre M, Scarsi PL, De Gennaro M, Battaglino F, Beseghi U, Di Lorenzo F, Cama A (2002) Caudal regression syndrome: an online multicentre survey. Urological long-term results. Eur J Pediatr Surg 12(Suppl 1):526–528

84.

Dave S, Pippi Salle JL, Lorenzo AJ, Braga LH, Peralta-Del Valle MH, Bägli D, Khoury AE (2008) Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction? J Urol 179(5):1991–1996PubMedCrossRef

Titel: Prevention of chronic kidney disease in spina bifida
verfasst von: Guido Filler
Mireille Gharib
Shelley Casier
Petra Lödige
Jochen H. H. Ehrich
Sumit Dave
Publikationsdatum: 01.06.2012
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 3/2012
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-010-9894-5

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Abstract

Objective

Removing the cause: prevention of spina bifida

The cause of CKD

Finding the ideal marker for measurement of renal function in spina bifida

(Video)Urodynamics studies (UDS)

Conclusion

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