Millner RO, et al. - Catheterized urine was obtained from 40 patients with neurogenic bladder (NGB) at a tertiary pediatric hospital and experts examined the role of albuminuria as a clinical marker of early renal disease in children with NGB in relationship with regularly used predictors of renal risk. Nearly 32% of NGB patients had increased albumin-to-creatinine ratio (ACR ≥ 30mg/g). On univariate analysis, raised ACR was related to the Caucasian race, clean intermittent catheterization, hydronephrosis, and vesicoureteral reflux. Notable predictors of ACR elevation were the presence of vesicoureteral reflux and the use of anticholinergic medication in multivariable analysis. In conclusion, of renal disease and risk for progression to renal failure, albuminuria is an authenticated clinical predictor. In NGB patients with urinary tract abnormalities, the presence of albuminuria suggests these patients may be at heightened risk for progressive renal disease. This supports the clinical utility of adding ACR to the assessment of renal risk in pediatric NGB.