ABSTRACT
Objective: Acute kidney injury (AKI) is a frequent complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to determine the incidence of renal replacement therapy (RRT) requirement in children undergoing surgical repair for congenital cardiopathies and identify the risk factors for requiring RRT. Patients and Methods: A retrospective, descriptive study was performed. The records of patients under 18 years undergoing cardiac surgery with CPB (January 2001 to July 2008) who required RRT (n = 15) and from a random patients sample that did not require it (n = 57) were analysed. Results: Fifteen children out of 942 required acute RRT (1.6 percent). Initial RRT was peritoneal dialysis (PD) in all of them. The main indications were hypervolemia and/or oligoanuria. Ten patients experienced complications associated to therapy and 14 patients had a history of serious intraoperative events. In multivariated analysis, hypotension (OR 36.0, CI 95 percent: 5.5-235.6) and serious low cardiac output (LCO) (OR 14.1, CI 95 percent: 1.47-135.32) were significant risk factors for RRT requirement. In turn, the presence of intraoperative events was significantly associated with the occurrence of hypotension (OR 28.9, CI 95 percent: 3.6-233.9) and LCO (OR 5.3, CI 95 percent: 1.126.6) during the post-surgical evolution. Conclusion: In this experience, severe hypotension and low cardiac output were significant risk factors for RRT requirement. The incidence of RRT was 1.6 percent. Renal function should be closely evaluated in those patients with surgical events. RRT should be early considered in those patients with risk factors for renal failure.
Introducción: La insuficiencia renal aguda es una complicación frecuente de la cirugía cardíaca con circulación extracorpórea (CEC). Objetivo: Determinar la incidencia de requerimiento de terapia de reemplazo renal (TRR) en niños sometidos a reparación quirúrgica de cardiopatías congénitas, caracterizarlos e identificar factores de riesgo de requerir TRR. Pacientes y Método: Se realizó un estudio retrospectivo descriptivo con un componente analítico. Se revisaron las fichas clínicas de los pacientes menores de 18 años sometidos a cirugía cardíaca con CEC (enero 2001 a julio 2008) que requirieron TRR (n = 15) y de una muestra aleatoria de pacientes que no la requirieron (n = 57). Resultados: De los 942 niños operados, 15 requirieron TRR aguda (1,6 por ciento). En todos, la TRR inicial fue peritoneodiálisis (PD). Las principales indicaciones fueron hipervolemia y/o oligoanuria. Diez pacientes presentaron complicaciones asociadas a la terapia y 14 tenían antecedentes de incidentes intraoperatorios graves. En forma multivariada, la hipotensión arterial (OR 36,0 IC 95 por ciento: 5,5-235,6) y el hipodébito grave (OR 14,1 IC 95 por ciento: 1,47-135,32) fueron factores de riesgo significativos de requerir TRR. A su vez, la presencia de incidentes intraoperatorios se asoció significativamente al desarrollo de hipotensión (OR 28,9 IC 95 por ciento: 3,6-233,9) e hipodébito (OR 5,3 IC 95 por ciento: 1,1-26,6) durante la evolución post-quirúrgica.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Extracorporeal Circulation , Acute Kidney Injury/therapy , Cardiac Surgical Procedures/adverse effects , Renal Replacement Therapy/methods , Heart Defects, Congenital/surgery , Acute Kidney Injury/etiology , Peritoneal Dialysis , Postoperative Care , Cardiac Surgical Procedures/methods , Retrospective Studies , Risk FactorsABSTRACT
Post transplant lymphoproliferative disorder (PTLD) is the commonest form of post transplant malignancy in children. The incidence in renal transplant recipients varies between 2 percent-4 percent. They are characterized by uncontrolled B lymphocyte proliferation, in most cases driven by Epstein Barr virus (EBV). They are more common in younger children, EBV seronegative patients and those who receive aggressive immunosuppression. PTLD commonly presents in an unspecific form and it requires high suspicion rate for its diagnosis, especially in children with risk factors. We report a twelve year-old girl who developed fever, sore throat and lymph node enlargement, six months after receiving a renal allograft. Laboratory assessment and imaging studies were compatible with PTLD, which was confirmed by biopsy. Treatment was reduction of immunosuppression and surveillance. The patient had a favorable evolution.
Subject(s)
Child , Female , Humans , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Lymphoproliferative Disorders/etiology , Sirolimus/adverse effects , Lymphoproliferative Disorders/pathology , Postoperative Complications/drug therapyABSTRACT
Los fenómenos tromboembólicos en pacientes con síndrome nefrótico constituyen una de las complicaciones más temidas debido al riesgo vital asociado. Objetivo: Describir los principales mecanismos fisiopatológicos responsables del desarrollo de este tipo de complicación a propósito de cuatro casos clínicos, en tres de los cuales se describen fenómenos tromboembólicos cerebrales y en uno trombosis extensa de extremidad inferior asociado a dificultad respiratoria. Las interacciones entre cuatro condiciones: actividad desbalanceada entre moléculas procoagulantes y anticoagulantes, trombocitosis, hiperagregación plaquetaria e hiperviscosidad sanguínea, promueven un estado de hipercoagulabilidad que conduce al desarrollo de complicaciones tromboembólicas, sin embargo, los mecanismos fisiopatólogicos subyacentes no han sido completamente aclarados. La presencia de otros factores tales como infecciones, complejos inmunes circulantes, hipovolemia, hipertensión, terapia esteroidal, punciones venosas e inmovilización pueden jugar un rol en la trombogénesis asociada al síndrome nefrótico. Conclusión: El síndrome Nefrótico representa una condición de alto riesgo de tromboembólismo, y requiere consideraciones terapéuticas tales como el uso criterioso de diuréticos, prevención de infecciones, mantenimiento de niveles adecuados de albúmina y el uso de fármacos antiplaquetarios y/o anticoagulantes.
Subject(s)
Male , Female , Child, Preschool , Child , Adolescent , Humans , Nephrotic Syndrome/complications , Thromboembolism/diagnosis , Thromboembolism/etiology , Thromboembolism/drug therapy , Anticoagulants/therapeutic use , Heparin/therapeutic use , Treatment OutcomeABSTRACT
Background:Hemolytic uremic syndrome (HUS) is one of the main causes of acute renal failure in the Chilean pediatric population. Aim: To report the features of patients with HUS, admitted to the pediatric ward of a clinical hospital. Material and methods: Retrospective review of medical records of patients admitted with the diagnosis of HUS between 1995 and 2002. Results: During the period, 58 patients were admitted with the diagnosis of HUS but only 43 (age range 1 month to 6 years, 22 females) had complete medical records for review. Ninety five percent presented with prodromic diarrhea, mainly dysenteric. Antibiotics were administered to 70%, in the previous days. Acute renal replacement, mainly peritoneal dialysis, was required in 40%. The clinical signs and laboratory parameters that correlated better with the indication for dialysis were anuria, hypertension, initial and permanently high serum creatinine and blood urea nitrogen. Four patients with blood urea nitrogen over 100 mg/dl but without anuria or hyperkalemia, were treated conservatively, and experienced an uneventful course (permissive azotemia). Hospital stay was almost 3 times greater in dialyzed than in non dialyzed children. No deaths related to HUS were reported in the study period. In an average follow up of 54 months, 11.6% of the patients developed chronic renal failure of diverse magnitude. Conclusions: Despite the fact that our study group behaved clinically similar to published HUS patients in other series, no mortality was observed in a retrospective analysis of patients with this disease.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Acute Kidney Injury , Hemolytic-Uremic Syndrome/therapy , Acute Kidney Injury , Escherichia coli Infections/complications , Follow-Up Studies , Hemolytic-Uremic Syndrome/complications , Hemolytic-Uremic Syndrome/physiopathology , Hospitalization , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/physiopathology , Retrospective StudiesABSTRACT
Background: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intra-abdominal complications. Aim: To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. Material and methods: Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. Results: The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with peritoneal dialysis solution was added in five patients, to improve azotemia. Four patients had complications related to the vascular access or the anticoagulation procedure. The procedure was terminated due to improvement of diuresis in five cases, transfer to PD in four and a cardiorespiratory arrest in one. Only one patient developed a chronic renal failure during the follow up. Conclusions: CHF is an effective and safe alternative of acute renal replacement therapy in the management of renal failure in pediatric cases with HUS, aggravated with abdominal complications