Renal function in meningomyelocele: risk factors, chronic renal failure, renal replacement therapy and transplantation

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Abstract
This review is on renal function in patients with spina bifida. Risk factors for renal injury as well specific issues concerning the treatment of chronic renal failure, renal replacement therapy and kidney transplantation are discussed. Relevant work published earlier than 2000 is also considered because of a lack of recent literature. Data from adult and paediatric surveys show renal damage to be the single most prevalent cause of morbidity and mortality; even in children, 30-40% exhibit evidence of renal damage. Additional factors such as chronic infection and stone formation will then render the kidney more vulnerable to progressive loss of renal mass and subsequent chronic renal failure. As in other patients with renal insufficiency, the control of hypertension, preferably with angiotensin-converting enzyme inhibitors, and adequate nutrition are mainstays of nephrological care. The modality of dialysis in these patients is complicated by ventriculoperitoneal shunts or urinary stomata in peritoneal dialysis, or difficult vascular access in haemodialysis. Renal transplantation is now considered the optimal treatment for end-stage renal disease in all age groups. Although more prone to complications, recent data on patients with meningomyelocele or severely abnormal lower urinary tracts demonstrate excellent patient and graft outcomes. The common goal in caring for these patients must be the prevention of progressive renal damage. However, once kidney failure has occurred, good and safe techniques for renal replacement therapy are available to bridge the time to transplantation, which is undoubtedly the best treatment for these patients.

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