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Publication of the Medical Rehabilitation is under the auspices of the Committee on Rehabilitation, Physical Education and Social Integration of the Polish Academy of Science
Article
Medical Rehabilitation - quarterly journal
Volume 11 year 2007, Issue number 3
Contemporary methods of urinary system evaluation in patients after spinal injury complicated by neurological deficits: Diagnostics of the upper urinary tract
Authors: Piotr Tederko, Jacek Lewandowski, Marek Krasuski, Jerzy Kiwerski
Medical Rehabilitation 2007; 11(3): 21-28
Contemporary methods of urinary system evaluation in patients after spinal injury complicated by neurological deficits: Diagnostics of the upper urinary tract
Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi - diagnostyka górnych dróg moczowych
Piotr Tederko 1,2, Jacek Lewandowski 3, Marek Krasuski 1,2, Jerzy Kiwerski 1,2
1 Department of Rehabilitation; Medical University of Warsaw, Poland
2 Second Department of Rehabilitation; Rehabilitation Centre, Konstancin, Poland
3 Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Poland
Key words
spinal injury, neurological deficits, urinary system, urinary tract
Abstract
Introduction: Morbidity and mortality related to urinary tract diseases in patients after spinal injury with neurological disturbances (SIND) are modificable if prompt and rational diagnostics and therapy are implemented in comprehensive care. SIND increases the risk of urinary tract damage resulting from neurogenic bladder dysfunction, sequels of patient's immobilisation, nephrotoxic effect of pharmacotherapy, necessity of bladder catheterisation. Severe damage to the urinary system resulting from reflux, urolithiasis, hydronephrosis, recurrent pyelonephritis can occur both during the early and the late phase following SIND. The risk of urinary tract cancer is markedly increased in SIND patients. The natural history of urinary tract diseases in SIND patients might be changed. The course of the disease can be scant in symptoms and singns until late stages.
Study design: Overview of scholarly literature.
Aim of the study: Presentation and analysis of clinical usefulness of modern tests applied in diagnostics of the urinary tract function in SIND patients. We discussed appropriateness and clinical usefulness of imaging and functional procedures of the upper urinary tract evaluation with special emphasis on basic laboratory tests, modern methods of glomerular filtration rate (GFR) assessment in SIND patients, as well as on the traditional and modern imaging studies.
Conclusions: Modern comprehensive care of a patient with SIND, both at the early and late stage following spinal injury, should comprise systematic monitoring of renal fucntion. Efficacious diagnosis is based on meticulous clinical examination. Auxilliary tests are performed according to their availability and the anticipated clinical relevance. First line diagnostic tests should comprise non-invasive techniques. Systematic and credible GFR assessment is indicated in SIND patients. Tests of choice include: 51CrEDTA or 99mTcDTPA clearance, assessemnt of cystatin-C level, as well as routine imaging studies of the kidneys such as renal radioisotope scanning and ultrasound examination. Urography and computed tomography may serve as auxiliary imaging techniques.
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