Can We Further Improve the Quality of Nephro-Urological Care in Children with Myelomeningocele?
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.
Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow 30-663, Poland. mmiklasz@wp.pl.
Monika
M
Miklaszewska
Department of Electronics, Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Cracow 30-059, Poland. korohoda@agh.edu.pl.
Przemysław
P
Korohoda
Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow 30-663, Poland. katarzyna.zachwieja@gmail.com.
Katarzyna
K
Zachwieja
Department of Pediatric Urology, Jagiellonian University Medical College, Cracow 30-663, Poland. miwolnic@gmail.com.
Michał
M
Wolnicki
Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, 02-091, Poland. mmizerskawasiak@op.pl.
Małgorzata
M
Mizerska-Wasiak
Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow 30-663, Poland. dadrozdz@cm-uj.krakow.pl.
Dorota
D
Drożdż
Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow 30-663, Poland. jacek.a.pietrzyk@gmail.com.
Jacek A
JA
Pietrzyk
D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D058996:Quality Improvement; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
children; chronic kidney disease; myelomeningocele; renal scintigraphy; urinary tract infection