7/25/2019 Case Report Ckd and Vur in Spina Bifida
1/20
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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
2/20
%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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
3/20
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 $ut no ou(h" no
#e
7/25/2019 Case Report Ckd and Vur in Spina Bifida
4/20
&)*SIC%+ E,%IN%"I#N
)eneral ondition = Se
7/25/2019 Case Report Ckd and Vur in Spina Bifida
5/20
normal limit" ph!siolo(ial re#le. &as normal" patolo(ial re#le. &ere not #ound, Sensi$ilit!
normal" Autonomial ner
7/25/2019 Case Report Ckd and Vur in Spina Bifida
6/20
&icture .Ultrasono(raph
i
7/25/2019 Case Report Ckd and Vur in Spina Bifida
7/20
%xial
C"
Chan(e in thoraolum$al
7/25/2019 Case Report Ckd and Vur in Spina Bifida
8/20
drops/min" Continue the anti$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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
9/20
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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
10/20
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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
11/20
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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
12/20
Folate is in
7/25/2019 Case Report Ckd and Vur in Spina Bifida
13/20
ha
7/25/2019 Case Report Ckd and Vur in Spina Bifida
14/20
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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
15/20
;P@ 0:: IU/k(W di
7/25/2019 Case Report Ckd and Vur in Spina Bifida
16/20
, 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 $ladder muosa and detrusor musle" reatin( a
#lap
7/25/2019 Case Report Ckd and Vur in Spina Bifida
17/20
approah ould redue a$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
7/25/2019 Case Report Ckd and Vur in Spina Bifida
18/20
#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 $ene#it #or (i
7/25/2019 Case Report Ckd and Vur in Spina Bifida
19/20
treatment o# (rades I and II re#lu. &as 52"+ 7" 56 7 #or (rade III" 9* 7 #or (rade I" and +0
7 #or (rade %)rade I" Reommendation A', -he a((re(ate sues rate &ith one or more
inBetion &as 2+ 7 00
In open sur(ial tehni?ue"
7/25/2019 Case Report Ckd and Vur in Spina Bifida
20/20
Foli Aid, Iron supplementation &as postpone until the reha$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
Top Related