The Effect of Intravesical Pressure on Glomerular Filtration Rate in Patients with Myelomeningocele

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Abstract
Numerous investigators have demonstrated the development of hydronephrosis and renal deterioration in patients with myelomeningocele who have high pressure bladders. By drawing blood at sequential intervals during 99mtechnetium-diethylenetriaminepentaacetic acid renal scanning we are able to generate nuclide clearance curves that correlate well with glomerular filtration rate. Renal scanning is done most frequently with the bladder catheterized and left to gravity drainage. By filling the bladder under manometric control to a pressure of 35 to 40 cm. water we have followed routine scanning with continued blood sampling to generate nuclide clearance at low and high bladder pressures. In 5 myelomeningocele patients so studied we found consistent and significant decreases in glomerular filtration rate at high bladder pressures.