title: Prevention of chronic kidney disease in spina bifida.
abstract: OBJECTIVE
  The prevalence of progressive chronic kidney disease (CKD) in children and adults with spina bifida is considerable, rising, and entirely preventable.
  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.
  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.
  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 (99m)Tc 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.
  
  
  CONCLUSIONS
  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 (99m)Tc DMSA scans have to be used to detect unilateral renal scarring.
authors.affiliation: Department of Pediatrics, Children's Hospital at London Health Science Centre, University of Western Ontario, 800 Commissioners Road East, London, ON N6A 5W9, Canada. guido.filler@lhsc.on.ca
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
authors.forename: Mireille
authors.initials: M
authors.lastname: Gharib
authors.forename: Shelley
authors.initials: S
authors.lastname: Casier
authors.forename: Petra
authors.initials: P
authors.lastname: Lödige
authors.forename: Jochen H H
authors.initials: JH
authors.lastname: Ehrich
authors.forename: Sumit
authors.initials: S
authors.lastname: Dave
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology* / Q000517:prevention & control* / Q000652:urine; D016135:Spinal Dysraphism / Q000150:complications* / Q000517:prevention & control; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000628:therapy; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications*
chemical_list: D015415:Biomarkers