Liu Xiaodong,Li Shoulin,Jiang Junhai,et al.Analysis of causes of chronic kidney disease associated with conservative treatment of neurogenic bladder in children[J].Journal of Clinical Pediatric Surgery,,20():1011-1015.[doi:10.12260/lcxewkzz.2021.11.003]
Analysis of causes of chronic kidney disease associated with conservative treatment of neurogenic bladder in children
- CLC:
- R726.945;R726.9;R726.92
- Abstract:
- Objective To explore the causes of chronic kidney disease (CKD) due to neurogenic bladder (NB) in children during the conservative treatment. Methods A retrospective study was conducted for 25 children with neurogenic bladder from January 2015 to January 2020. The patients’ estimated glomerular filtration rate (eGFR) was measured by Schwartz formula based upon serum creatinine level. They were divided into two groups. Group A:patients with CKD stage 3 or above (n=8). Group B:patients with CKD stage 3 below (n=17). Clinical data of two groups were compared and statistically analyzed. Results There was no inter-group statistical difference in age or gender. eGFR was (23.6±13.8) mL·min-1·1.73 m-2 vs. (89.3±17.3) mL·min-1·1.73 m-2 with statistical difference. The age of first cleaning intermittent catheterization was 4(3, 5) vs. 2(2, 3.25) years old, frequency of outpatient follow-up visits in the first year after diagnosis of NB was 2(1, 2) vs. 4(3, 4.25) and the frequency of febrile urinary tract infection (fUTI) was 3(3, 4) vs. 2(1, 2.25), indicating statistically significant differences between two groups. Conclusion CKD may occur during conservative treatment of NB in children. Lack of early clean intermittent catheterization, standardized follow-up and control of fUTI are important contributors for CKD.
References:
1 Bauer SB.Neurogenic bladder:etiology and assessment[J].Pediatr Nephrol, 2008, 23(4):541-551.DOI:10.1007/s00467-008-0764-7.
2 de Jong TP, Chrzan R, Klijn AJ, et al. Treatment of the neurogenic bladder in spina bifida[J].Pediatr Nephrol, 2008, 23(6):889-896.DOI:10.1007/s00467-008-0780-7.
3 Nevéus T, von Gontard A, Hoebeke P, et al. The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents:Report from the Standardisation Committee of the International Children’s Continence Society[J].Journal of Urology, 2006, 176(1):314-324.DOI:10.1016/s0022-5347(06)00305-3.
4 Manack A, Motsko SP, Haag-Molkenteller C, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database[J].Neurourol Urodyn, 2011, 30(3):395-401.DOI:10.1002/nau.21003.
5 Kari JA.Neuropathic bladder as a cause of chronic renal failure in children in developing countries[J].Pediatr Nephrol, 2006, 21(4):517-520.DOI:10.1007/s00467-006-0034-5.
6 Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes (KDIGO)[J].Kidney Int, 2005, 67(6):2089-2100.DOI:10.1111/j.1523-1755.2005.00365.x.
7 Chapter 1:Definition and classification of CKD[J].Kidney Int Suppl (2011), 2013, 3(1):19-62.DOI:10.1038/kisup.2012.64.
8 Schwartz GJ, Munoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD[J].J Am Soc Nephrol, 2009, 20(3):629-637.DOI:10.1681/ASN.2008030287.
9 文建国.小儿正常排尿与神经源性膀胱排尿异常[J].临床小儿外科杂志, 2008, 7(5):63-65.DOI:10.3969/j.issn.1671-6353.2008.05.022. Wen JG.Normal urination and neurogenic bladder urination abnormalities in children[J].J Clin Ped Sur, 2008, 7(5):63-65.DOI:10.3969/j.issn.1671-6353.2008.05.022.
10 Müller T, Arbeiter K, Aufricht C.Renal function in meningomyelocele:risk factors, chronic renal failure, renal replacement therapy and transplantation[J].Curr Opin Urol, 2002, 12(6):479-484.DOI:10.1097/00042307-200211000-00006.
11 Veenboer PW, Bosch JL, van Asbeck FW, et al. Upper and lower urinary tract outcomes in adult myelomeningocele patients:a systematic review[J].PLoS One, 2012, 7(10):e48399.DOI:10.1371/journal.pone.0048399.
12 McGuire EJ, Woodside JR, Borden TA.Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia:a followup study[J].Journal of Urology, 1983, 129(4):823-826.DOI:10.1016/s0022-5347(17)52384-8.
13 Sillén U, Hansson E, Hermansson G, et al. Development of the urodynamic pattern in infants with myelomeningocele[J].Br J Urol, 1996, 78(4):596-601.DOI:10.1046/j.1464-410x.1996.14417.x.
14 郑百俊, 李恭才, 张宪生, 等. 腰骶部脊髓脊膜膨出并发神经源性膀胱的临床研究[J].中华小儿外科杂志, 1997, 18(1):17-19.DOI:10.3760/cma.j.issn.0253-3006.1997.01.008. Zheng BJ, Li GC, Zhang XS, el al.Neurogenic bladder in lumbosacral myelomeningocele[J].Chin J Pediatr Surg, 1997, 18(1):17-19.DOI:10.3760/cma.j.issn.0253-3006.1997.01.008.
15 Wide P, Glad Mattsson G, Mattsson S.Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program[J].J Pediatr Urol, 2012, 8(2):187-193.DOI:10.1016/j.jpurol.2011.02.003.
16 Kaefer M, Pabby A, Kelly M, et al. Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele[J].J Urol, 1999, 162(3 Pt 2):1068-1071.DOI:10.1097/00005392-199909000-00031.
17 Dik P, Klijn AJ, van Gool JD, et al. Early start to therapy preserves kidney function in spina bifida patients[J].Eur Urol, 2006, 49(5):908-913.DOI:10.1016/j.eururo.2005.12.056.
18 Wu HY, Baskin LS, Kogan BA.Neurogenic bladder dysfunction due to myelomeningocele:neonatal versus childhood treatment[J].J Urol, 1997, 157(6):2295-2297.
19 Goessl C, Knispel HH, Fiedler U, et al. Urodynamic effects of oral oxybutynin chloride in children with myelomeningocele and detrusor hyperreflexia[J].Urology, 1998, 51(1):94-98.DOI:10.1016/s0090-4295(97)00489-5.
20 Lee JH, Kim KR, Lee YS, et al. Efficacy, tolerability, and safety of oxybutynin chloride in pediatric neurogenic bladder with spinal dysraphism:a retrospective, multicenter, observational study[J].Korean J Urol, 2014, 55(12):828-833.DOI:10.4111/kju.2014.55.12.828.
21 Bauer SB, Austin PF, Rawashdeh YF, et al. International Children’s Continence Society’s recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children[J].Neurourol Urodyn, 2012, 31(5):610-614.DOI:10.1002/nau.22247.
22 孙小兵, 李殿国, 罗添华, 等. 膀胱自体扩大术在神经性膀胱患者中的应用评价[J].临床小儿外科杂志, 2016, 15(4):371-373, 378.DOI:10.3969/j.issn.1671-6353.2016.04.018. Sun XB, Li DG, Luo TH, et al. Clinical evaluations of bladder autoaugmentation in children with neurogenic bladder dysfunction[J].J Clin Ped Sur, 2016, 15(4):371-373, 378.DOI:10.3969/j.issn.1671-6353.2016.04.018.
23 Pan Y, Yang Xh, He JP, et al. To be or not to be a doctor, that is the question:a review of serious incidents of violence against doctors in China from 2003-2013[J].Journal of Public Health, 2015, 23(2):111-116.DOI:10.1007/s10389-015-0658-7.
24 Sun J, Liu S, Liu Q, et al. Impact of adverse media reporting on public perceptions of the doctor-patient relationship in China:an analysis with propensity score matching method[J].BMJ Open, 2018, 8(8):e022455.DOI:10.1136/bmjopen-2018-022455.
25 Stein R, Bogaert G, Dogan HS, et al. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment[J].Neurourol Urodyn, 2020, 39(1):45-57.DOI:10.1002/nau.24211.
26 文建国, 李云龙, 袁继炎, 等. 小儿神经源性膀胱诊断和治疗指南[J].中华小儿外科杂志, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002. Wen JG, Li YL, Yuan JY, et al. Guidelines for the diagnosis and treatment of neurogenic bladder in children[J].Chin J Pediatr Surg, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002.
27 Lucas EJ, Baxter C, Singh C, et al. Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization[J].J Pediatr Urol, 2016, 12(3):172.e1-172.e1728.DOI:10.1016/j.jpurol.2015.12.012.
28 Sung BM, Oh DJ, Choi MH, et al. Chronic kidney disease in neurogenic bladder[J].Nephrology, 2018, 23(3):231-236.DOI:10.1111/nep.12990.
Memo
收稿日期:2021-02-24。
基金项目:国家自然科学基金委联合基金项目（编号：U1904208）；广东省医学科学技术研究基金项目（编号：A2018341）；深圳市医疗卫生三名工程（编号：SZSM201612013）；深圳市医学重点学科（编号：（2020-2024）（SZXK035））
通讯作者:李守林,Email:lishoulinsz@126.com