Abstract
Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years.
Highlights
Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development
There are studies confirming that the severity of Vesicouretral reflux (VUR) and febrile recurrent urinary tract infection (UTI) affects the likelihood of renal scarring and renal deterioration [12,13]
In MMC patients, the presence of high-grade VUR is correlated with febrile UTIs
Summary
Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Including spina bifida (SB), it is one of the most common non-chromosomal birth defects, resulting in a severe damage of numerous organs. The incidence of MMC ranges from 0.3 to 4.5/1000 births [1]. In Poland, great efforts are made to treat all children born with MMC, such patients constitute a vast number of children seen by pediatric nephrologists, urologists, and primary care physicians; the affected patients require to be promptly evaluated and subjected to long-term follow-up. The prognosis of MMC in children has dramatically improved, predominantly thanks to the use of superior surgical and shunt implantation. Res. Public Health 2016, 13, 876; doi:10.3390/ijerph13090876 www.mdpi.com/journal/ijerph
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