New study reveals hidden kidney dysfunction in children with cloacal malformations - Children's National

Children born with cloacal malformations face many medical challenges beyond surgery. One major concern is kidney health, which may not always be obvious at first. In a recent study published in the Journal of Pediatric Urology, experts at Children's National Hospital found that many of these children show early signs of kidney problems, often related to abnormalities in the kidneys or urinary tract that are present from birth.

How does this work move the field forward?

In the past, doctors did not fully understand why some children with cloaca develop chronic kidney disease (CKD). Earlier studies showed that about 6% of children with complex cloaca needed a kidney transplant by around age 10, but the exact cause of their kidney problems was unclear.

"Our study shows that some kidney damage in children with cloaca actually begins before birth and is linked to problems in the kidneys or urinary tract that are present from the start," said Briony Varda, MD, MPH, urologist in the Division of Urology and the Division of Colorectal and Pelvic Reconstruction at Children's National. "This early damage may reduce a child's kidney reserve, but it may not show up on common blood tests like serum creatinine."

By using newer, more accurate ways to measure kidney function, such as the CKID U25 GFR formula, researchers were able to detect hidden kidney problems that standard tests might miss. This helps doctors identify at-risk children earlier and take steps to protect their kidney health over time.

What did you find that excites you?

The study found that children with cloacal anomalies can have kidney problems from birth, even when routine tests look normal.

"These findings raise important questions for care," Dr. Varda said. "Can careful management slow kidney damage, or is it set before birth? How will these early kidney issues affect patients as they grow?"

Understanding these answers could help doctors plan better long-term care and protect kidney health throughout childhood and beyond.

How is Children's National leading in this space?

Children's National has performed more primary cloaca repairs than any other hospital in the U.S. over the past five years, according to national data.

"Our team works closely in the operating room and with many specialists outside the OR," Dr. Varda said. "For this study, our kidney expert, Melissa Meyers, MD, contributed her guidance. Since 2020, we've also maintained a careful database that tracks outcomes for this rare condition. This work helps us learn and improve care for every patient."

Read the full study, Glomerular Filtration Rate (GFR) measures in young children with cloacal malformations indicate early baseline renal dysfunction which is independently associated with congenital upper urinary tract anomalies, in the Journal of Pediatric Urology.

Additional Children's National contributors include doctors across Urology, Nephrology, Colorectal and Fetal Medicine: Christopher Staniorski, MD, Christopher Corbett, MD, Butool Hisam, MD, Melanie Bowser, MD, Allison Mayhew, MD, Christina P. Ho, MD, Hans G. Pohl, MD, Christina Feng, MD, Andrea Badillo, MD, Marc Levitt, MD, Melissa Meyers, MD.