Abstract
Purpose
Patients with neurogenic lower urinary tract dysfunction (nLUTD) can be at risk of preventable damage to the upper urinary tract (UUT), a risk that varies with the underlying diagnosis. Existing literature fails to document precisely which domains of UUT must be followed. This review focusses on surveillance of UUT with special emphasis on high-risk nLUTD.
Methods
Narrative review of available evidence and current global guidelines to identify patients of nLUTD at higher risk of UUT damage and to define each domain that needs to be followed.
Results
Patients with open spina bifida, spinal cord injury, and anorectal malformation, as well as those with unsafe features on clinical evaluation or urodynamics should be considered at high risk. Structured program should include evaluation of (1) glomerular filtration rate (GFR) which can be estimated ± measured, (2) renal growth (in pre-pubertal children) by ultrasonography, (3) renal scarring by baseline nuclear renogram, (4) hydronephrosis and stones by ultrasonography, (5) vesicoureteral reflux by baseline video-urodynamics, (6) non-GFR measures of renal function (somatic growth, hypertension, proteinuria, anemia and metabolic acidemia). Serum creatinine-based estimations of GFR are more likely to be confounded in select patients with high-risk nLUTD than cystatin-based estimations and measured-GFR. Urological guidelines do not always describe details of UUT surveillance and appear to lack cognizance of nephrology guidelines for evaluation of kidneys.
Conclusion
A structured surveillance protocol that includes clear documentation of each domain of the UUT is important in ensuring optimum care for patients with high-risk nLUTD.
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References
Bauer SB (2008) Neurogenic bladder: etiology and assessment. Pediatr Nephrol 23:541–551
Filler G, Gharib M, Casier S et al (2012) Prevention of chronic kidney disease in spina bifida. Int Urol Nephrol 44:817–827
Wang H-HS, Lloyd JC, Wiener JS et al (2016) Nationwide trends and variations in urological surgical interventions and renal outcome in patients with spina bifida. J Urol 195:1189–1194
Elliot S, Gomez R (2017) Urologic management of the spinal cord injured patient. International Consultation on Urologic Disease. Société Internationale d’Urologie, Montreal
Kanaheswari Y, Mohd Rizal AM (2015) Renal scarring and chronic kidney disease in children with spina bifida in a multidisciplinary Malaysian centre. J Paediatr Child Health 51:1175–1181
Danforth TL, Ginsberg DA (2014) Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics? Urol Clin N Am 41:445–452, ix
Anon (2012) Introduction | Urinary incontinence in neurological disease: assessment and management | Guidance | NICE. https://www.nice.org.uk/guidance/cg148/chapter/introduction. Accessed 26 Mar 2023
Kavanagh A, Baverstock R, Campeau L et al (2019) Canadian Urological Association guideline: diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction—full text. Can Urol Assoc J 13:E157–E176
Blok B, Pannek J, Castro-Diaz G et al (2023) Neuro-urology. European Association of Urology Guidelines. https://uroweb.org/guideline/neuro-urology/. Accessed 14 Apr 2023
Komatsu H, Oishi T, Osaku D et al (2020) Long-term evaluation of renal function and neurogenic bladder following radical hysterectomy in patients with uterine cervical cancer. J Obstet Gynaecol Res 46:2108–2114
Tarcan T, Demirkesen O, Plata M et al (2017) ICS teaching module: detrusor leak point pressures in patients with relevant neurological abnormalities. Neurourol Urodyn 36:259–262
Li Q, Cai M, Pu Q et al (2022) A nomogram for predicting upper urinary tract damage risk in children with neurogenic bladder. Front Pediatr 10. https://www.frontiersin.org/articles/10.3389/fped.2022.1050013. Accessed 26 Mar 2023
Mian AN, Schwartz GJ (2017) Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis 24:348–356
Banfi G, Del Fabbro M, Lippi G (2009) Serum creatinine concentration and creatinine-based estimation of glomerular filtration rate in athletes. Sports Med 39:331–337
Delanaye P, Cavalier E, Pottel H (2017) Serum creatinine: not so simple! Nephron 136:302–308
Vart P, Grams ME (2016) Measuring and assessing kidney function. Semin Nephrol 36:262–272
Dangle PP, Ayyash O, Kang A et al (2017) Cystatin C-calculated glomerular filtration rate—a marker of early renal dysfunction in patients with neuropathic bladder. Urology 100:213–217
Ginsberg DA, Boone TB, Cameron AP et al (2021) The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J Urol 206:1097–1105
Warwick J, Holness J (2022) Measurement of glomerular filtration rate. Semin Nucl Med 52:453–466
Rabadi MH, Aston CE (2016) Compare serum creatinine versus renal (99m)Tc-DTPA scan determined glomerular filtration rates in veterans with traumatic spinal cord injury and meurogenic bladder. J Spinal Cord Med 39:638–644
DeFreitas MJ, Katsoufis CP, Infante JC et al (2021) The old becomes new: advances in imaging techniques to assess nephron mass in children. Pediatr Nephrol 36:517–525
Chung EM, Soderlund KA, Fagen KE (2017) Imaging of the pediatric urinary system. Radiol Clin N Am 55:337–357
Shipstone DP, Thomas DG, Darwent G et al (2002) Magnetic resonance urography in patients with neurogenic bladder dysfunction and spinal dysraphism. BJU Int 89:658–664
Somu S, Sundaram B, Kamalanathan A (2003) Early detection of hypertension in general practice. Arch Dis Child 88:302
Anon: The WHO child growth standards. https://www.who.int/tools/child-growth-standards. Accessed 23 Mar 2023
De Benoist B, McLean E, Egli I et al (2008) Worldwide prevalence of anaemia 1993–2005: WHO Global Database on Anaemia. In: de Benoist B, McLean E, Egli I, Cogswell M (eds) World Health Organization. Geneva. https://apps.who.int/iris/handle/10665/43894
Anon (2021) Recommendations | Chronic kidney disease: assessment and management | Guidance | NICE. https://www.nice.org.uk/guidance/ng203/chapter/Recommendations#investigations-for-chronic-kidney-disease. Accessed 24 Mar 2023
Cho MH (2022) Measurement of urinary protein in children. Child Kidney Dis 26:69–73
Raphael KL (2019) Metabolic acidosis in CKD: core curriculum 2019. Am J Kidney Dis 74:263–275
Anon: Estimating glomerular filtration rate—NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/laboratory-evaluation/glomerular-filtration-rate/estimating. Accessed 13 Apr 2023
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Sinha, S. Follow-up for the upper urinary tract in patients with high-risk neurogenic lower urinary tract dysfunction. World J Urol 41, 3309–3316 (2023). https://doi.org/10.1007/s00345-023-04602-w
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DOI: https://doi.org/10.1007/s00345-023-04602-w