Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study.
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Doğan Çağla Serpil, Taner Sevgin, Tiryaki Betül Durucu, Alaygut Demet, Özkayın Neşe, Kara Aslıhan, Gençler Aylin, Pınarbaşı Ayşe Seda, Nalçacıoğlu Hülya, Yüksel Selçuk, Akacı Okan, Yılmaz Esra Karabağ, Yavuz Sevgi, Doğan Kenan, Gülşan Rumeysa Yasemin Çiçek, Aksoy Gülşah Kaya, Çiçek Neslihan, Aksu Bağdagül, Küçük Nuran, Altugan Fatma Şemsa, Selçuk Şenay Zırhlı, Baştuğ Funda, Erfidan Gökçen, Atmış Bahriye, Gökçeoğlu Arife Uslu, Önder Esra Nagehan Akyol, Elmacı Ahmet Mithat, Cengiz Nurcan, Gülleroğlu Kaan, Yılmaz Ebru Bekiroğlu, Tayfur Aslı Çelebi, Yılmaz Gülsün Gülay, Yel Sİbel, Pehlivanoğlu Cemile, Akgün Cihangir, Kara Mehtap Akbalık, Kılıç Beltinge Demircioğlu, Şimşek Özgür Özdemir, Yucal Melike, Ağar Buket Esen, Gürgöze Metin Kaya, Yağmur İsmail, Madsar Ömer, Karalı Demet Tekcan, Girişgen İlknur, Bodur Ece Demirci, Çomak Elif, Gökçe İbrahim, Kaya Mehtap, Tabel Yılmaz, Günay Neslihan, Gülmez Rüveyda, Çalışkan Salim
Аннотация
METHODS: Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group.
RESULTS: A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old.
CONCLUSION: MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.