title: Preservation of renal function in the modern staged repair of classic bladder exstrophy.
abstract: OBJECTIVE
  To compare the estimated glomerular filtration rate (eGFR) in bladder exstrophy patients with published normative GFR estimates.
  
  
  METHODS
  eGFR was calculated using the Schwartz formula at three timepoints, with mean eGFR at each timepoint compared to normative values.
  
  
  RESULTS
  At primary closure (n = 53) the mean eGFR (ml/min/1.73 m(2)) in exstrophy patients was similar to norms at 0-7 days (exstrophy vs norm: 42.5 vs 40.6, p > 0.05) and after 2 years of age (108.8 vs 133, p > 0.05). However, the mean eGFR in exstrophy patients was significantly lower than norms between 8 days (44.8 vs 65.8, p < 0.0001) and 2 years of life (68 vs 95.7, p = 0.01). At bladder neck reconstruction (n = 13) no statistically significant difference existed between the exstrophy and normative eGFR values (137.1 vs 133, p > 0.05). Similarly, among 27 patients with at least 1 year follow-up after bladder neck reconstruction, the mean exstrophy eGFR was no worse or higher than normative values (2-12 years: 124.5 vs 133, p > 0.05; males ≥13 years 175.6 vs 140, p = 0.04; females ≥13 years 128.8 vs 126, p > 0.05).
  
  
  CONCLUSIONS
  The staged reconstruction of exstrophy does not appear to negatively impact renal function in most patients. As eGFR detects only significant changes, surgical reconstruction may still cause more subtle renal damage.
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. aschaeffer78@gmail.com
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Schaeffer
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
authors.forename: Ranjiv I
authors.initials: RI
authors.lastname: Mathews
mesh_terms: D000293:Adolescent; D001746:Bladder Exstrophy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008954:Models, Biological; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D019651:Plastic Surgery Procedures / Q000379:methods*; D014463:Ultrasonography; D014521:Urethra / Q000502:physiology; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery; D014554:Urination / Q000502:physiology*; D013520:Urologic Surgical Procedures / Q000379:methods*