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English Case Report

Nephrology Division

Chronic Kidney Disease Stage IV and Vesicoureteral Reflux Grade IV - V

in Spina ifida

Raedy Ru!anda Susanto

Departemen Ilmu Kesehatan Anak FK UNHAS/

RSUP dr Wahidin Sudirohusodo Makassar

IN"R#D$C"I#N

Chroni kidne! disease" de#ined as a$normalit! o# the renal #untion %kno&n #rom the

serum reatinine'" urinanal!sis" and ima(in( %kno&n #rom the US) ' at least * months" and

lassi#ied as + (rade, -his dereasin( #untion make to.i meta$oli aumulate in serum"

and imparment o# &ater" eletrol!te and aid$ase im$alane,

In Indonesia" $et&een 0123 4 0122 in 5 entral hospital inidene o# CKD is 6 7#rom 6221 hildren hospitali8ed &ith all kidne! disease, In Cipto Man(unkusomo Hospital"

inidene o# CKD si(ni#iantl! inreasin(" #rom 3" 1 7 in 0110 $eame 0*"* 7 in 0119 4

6::: period, Whereas in ;urope" pre

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%nelson', -here are man! N-Ds inlude spina $i#ida" and its lassi#ied as spina $i#ida

oulta" menin(ohele" m!elomenin(ohele, M!elomenin(oele is the most in

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A $o!" Re#l! Me!8ar" 9 !ears and 0 month" re#er #rom $au$au hospital on

Septem$er 6:th" 6:0+ &ith dia(nosis hroni kidne! disease and hidronephrosis $ilateral,

Chief co'plaint= sine he &as 0 !ears old" o#ten aompanied $! disuria,

%dditional co'plaint ( -here &ere #lank pain sine 3 da! $e#ore admission" s&ollen in the

lo&er &aist sine he &as $orn" no pain, -here &as shortness o# $reath $ut no ou(h" no

#e

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&)*SIC%+ E,%IN%"I#N

)eneral ondition = Se

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normal limit" ph!siolo(ial re#le. &as normal" patolo(ial re#le. &ere not #ound, Sensi$ilit!

normal" Autonomial ner

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&icture .Ultrasono(raph

i

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%xial

C"

Chan(e in thoraolum$al

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drops/min" Continue the anti$iotis e#ota.ime and amikain" ni#edipine + m(/S" and

addition o# aptopril +m(/2 hr/N)-" #urosemide 0: m(/06 hr/N)- #or antih!pertensi

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trans#usion'" WC 0*,+5:" P- *:6,:::" Ht 61"9" UN 22" Creatinine 0"95 " Al$umin 6"1

Sodium 0+0" Pottasium +"+" Chlorida 066 mmol/ -herap! = o.!(en nasal 6 /min" IFD

Kaen * 03 drops/min" Continue the anti$iotis e#ota.ime and amikain" ni#edipine +

m(/S" aptopril +m(/2 hr/N)-" #urosemide 0: m(/06 hr/N)-,

Piture 5

*+ ml Iodium inserted to the

urinar! atheter" &ith

#luoroskop ontrast #illed the

$ladder and le#t ureter" &ith

tortous ureter,

Multiple additional shado& on$ladder" &ith irre(uler muosa"

#illin( de#et &as not sho&n,

A#ter atheter &as pulled o##"

ontrast pass out the urethra,

Result =

Suspeter $ladder di

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otrimo.a8ole 63: m(/63 Bam/orall!" stop the IFD" ni#edipine + m(/S" aptopril +m(/2

hr/N)-" and stop #urosemide 0: m(/06 hr/N)-

03 %3/0:/6:0+' = No d!spnoe " miturition

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0"0+ m(/dl ,e#i.ime 6 . th" aptopril +m(/2 hr/N)-" diet &ith ne#risol 2 . 6:: ml" patient

allo&ed to (o home and return to outpatient departement,

Definitive Diagnosis

Chroni Kidne! Disease Sta(e I esioureteral Re#lu. )rade I 4

Neuro(eni ladder Menin(o!stoele C!stitis Anemia $! Chroni Disease Nutritional Marasmus Short Stature

Discussion

Spina $i#ida is a (eneral name #or neural tu$e de#ets, It lassi#ied as man! diseases

inludin( menin(o!stoele or menin(om!eloele, M!elomenin(oele represents the most

se

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Folate is in

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ha

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lo& %hroni disease anemia',-he presene o# anemia in patients &ith CKD has a &ide

ran(e o# linial mani#estation" these inlude redued ph!sial per#ormane" #ati(ue"

shortness o# $reath" los o# appetite" insomnia" o(niti

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;P@ 0:: IU/k(W di

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, esiouretral re#lu. %UR' re#ers to the retro(rade #lo& o# urine #rom the $ladder to

the ureter and kidne!, It an ours primaril! and seondar!, -he ureteral attahment to the

$ladder normall! is o$li?ue" $et&een the $ladder muosa and detrusor musle" reatin( a

#lap

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approah ould redue a$out +:7 o# the num$er o# CU)s per#ormed &hile missin( a UR

dia(nosis in +7 to 657 o# ases" &ith the ases o# missed UR $ein( presuma$l! less

si(ni#iant,3" 00

Fi(ure 2 ottom up and -op do&n approah #or dia(nosin( UR 0:

Re#lu. se

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#ornies, )rade I = re#lu. into a (rossl! dilated ureter, )rade = Massi 6 mo' or trimetophrim 4 sul#ameto.a8ole or nitro#urantoin %older a(e'

pre#era$l! taken at $edtime, While some trials sho& no $ene#it #or (i

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treatment o# (rades I and II re#lu. &as 52"+ 7" 56 7 #or (rade III" 9* 7 #or (rade I" and +0

7 #or (rade %)rade I" Reommendation A', -he a((re(ate sues rate &ith one or more

inBetion &as 2+ 7 00

In open sur(ial tehni?ue"

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Foli Aid, Iron supplementation &as postpone until the reha$ilitation phase" aordin( to

iron #untion that an $e used #or miroor(anism nutrition, 06

S$%R*

A ase o# Chroni Kidne! Disease and esiouretral Re#lu. in Spina i#ida patient

has $een reported, -he dia(nosis &ere esta$lished $ased on histor! takin(" ph!sial

e.amination" la$orator! and radiolo(! #indin(, @.!(en" Anti$iotis" Antih!pertensi