To define the kidney risk associated with spina bifida, the age at which this risk becomes evident, and the contributing factors.
Approach:
Study Analysis: Examination of a large, population-level database to assess the incidence of chronic kidney disease (CKD) in individuals with spina bifida.
Key Findings:
A 9-fold increase in incidence of CKD among individuals with spina bifida compared to individuals without spina bifida.
CKD diagnosed at a younger age and progresses more rapidly compared to individuals without spina bifida.
Multiple risk factors for CKD include history of urolithiasis and urological surgery.
Kidney pathology accounted for over 25% of deaths in adults with spina bifida historically.
Infants with spina bifida have normal kidneys at baseline, indicating CKD is acquired.
Interpretation:
Kidney monitoring and early intervention are crucial for managing spina bifida patients, with cystatin C-based eGFR preferred for assessing kidney function.
Limitations:
Standard serum creatinine-based eGFR equations are unreliable due to reduced muscle mass in spina bifida patients, which complicates the assessment of kidney outcomes.
Variability in surgical interventions and their goals complicates the assessment of kidney outcomes.
Conclusion:
Future research should focus on granular surgical categorization and patient-level risk stratification to improve kidney protection strategies.
