Methods for Evaluating Renal Function in Patients with Neurogenic Bladder

Purpose of Review: Preventing kidney injury is a crucial part of caring for patients with spina bifida (SB). The purpose of our review is to evaluate and present the current literature on assessing kidney function in patients with SB. Recent Findings: Significant variability exists in how kidney abnormality is defined in the literature on patients with SB. Numerous centers of excellence in SB care within the National Spina Bifida Patient Registry lack concordance on kidney function surveillance strategies. Although there are various recently updated guidelines on the management of patients with SB, there is a lack of consensus on the best way to evaluate kidney function in these patients. Most guidelines that recommend specific surveillance strategies have not been empirically validated with high-quality research and instead are frequently based on a small amount of evidence. The Urologic Management to Preserve Initial Renal Function (UMPIRE) protocol for Young Children with Spina Bifida is a large quality improvement protocol currently following a cohort of newborns with SB at nine US centers. This prospective multicenter trial is currently ongoing and will guide future management strategies for patients with SB. Summary: Given the lack of high-quality effectiveness evidence and inconsistent guidelines, we recommend aggressive kidney surveillance with routine imaging and laboratory-based testing, ideally with both serum Cr and cystatin-C. Moreover, DMSA and GFR plasma clearance tests are powerful tools to further assess kidney function. Future research validating novel biomarkers and imaging markers in patients with SB is important to ensure accuracy in this patient population.