ABSTRACT
The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency. Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery.
Subject(s)
Acute Kidney Injury/therapy , Cardiopulmonary Bypass/adverse effects , Renal Replacement Therapy/methods , Acute Kidney Injury/etiology , Child, Preschool , Female , Humans , Infant , Logistic Models , Male , Peritoneal Dialysis/methods , Retrospective StudiesABSTRACT
Metabolic acidosis occurs frequently in small children. The most common causes are hypoxia, sepsis, gastroenteritis and hypovolaemia. Calculation of the anion gap is useful in establishing the cause. An increased anion gap represents unmeasured anions, e.g. lactate in lactic acidosis. Metabolic acidosis was diagnosed in two boys aged one year and six weeks respectively. The first patient had a normal, the second an increased anion gap in blood. By determining the pH and the anion gap in urine it is possible to distinguish between a proximal and a distal tubular disease. The first patient had distal renal tubular acidosis; he recovered after correction of the acidosis. The second patient had a defect in the mitochondrial respiratory chain; he died at the age of seven months.
Subject(s)
Acid-Base Imbalance/urine , Acidosis, Lactic/diagnosis , Acidosis, Renal Tubular/diagnosis , Acidosis, Lactic/etiology , Acidosis, Lactic/urine , Acidosis, Renal Tubular/complications , Acidosis, Renal Tubular/urine , Diagnosis, Differential , Fatal Outcome , Humans , Infant , Male , Mitochondrial Myopathies/complications , Mitochondrial Myopathies/diagnosis , Osteomalacia/complications , Sodium Bicarbonate/therapeutic useABSTRACT
A girl with psychomotor retardation is described in whom the diagnosis phenylketonuria (PKU) was made at the age of 6.5 years. Previous investigations were not carried out as she was screened for PKU when she was a baby. Since the nationwide neonatal screening for PKU was started in 1974, 4 children have been detected with a false negative test result.
Subject(s)
Developmental Disabilities/etiology , Phenylketonurias/blood , Phenylketonurias/complications , Celiac Disease/diagnosis , Child , Diagnosis, Differential , False Negative Reactions , Female , Humans , Infant, Newborn , Mass Screening , Phenylketonurias/diet therapyABSTRACT
The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1 g/kg/day) or the control group. All children were followed up by the same paediatrician and dietitian. After a follow up period of three years there was no significant difference in glomerular filtration rate between children on a protein restricted diet and children of the control group. There was no significant difference in weight with respect to height and height SD score between the protein restricted and the control group. Compliance with the protein restricted diet, as indicated by the prospective diet diaries and the serum urea:creatinine ratio, was good. This study shows that children with chronic renal failure do not benefit from a protein restricted diet.
Subject(s)
Dietary Proteins/administration & dosage , Kidney Failure, Chronic/diet therapy , Adolescent , Body Height , Body Weight , Child , Child, Preschool , Creatinine/blood , Female , Follow-Up Studies , Glomerular Filtration Rate , Humans , Kidney Failure, Chronic/physiopathology , Kidney Glomerulus/physiopathology , Male , Prospective Studies , Time FactorsABSTRACT
We assessed the relationship between protein intake (calculated from a 3-day prospective dietary diary) and 24-h urinary urea excretion in 37 children with chronic renal failure. Protein intake was not restricted during the investigation period. The 24-h urinary urea excretion correlated poorly with the protein intake estimated from the dietary diary (r = 0.58). We conclude that although it is common practice to assess compliance with a protein-restricted diet in children with chronic renal failure with a dietary diary and 24-h urinary urea excretion, the value of this assessment is questionable.
Subject(s)
Dietary Proteins/administration & dosage , Eating , Kidney Failure, Chronic/urine , Urea/urine , Adolescent , Child , Child, Preschool , Female , Humans , Male , Medical Records , Patient ComplianceABSTRACT
Cardiovascular complications in patients with chronic renal failure have been associated with the hyperlipidemia present in many of these patients. Since a protein-restricted diet is often prescribed in an attempt to preserve renal function, we performed a randomized controlled study in children with chronic renal failure on the effect of a protein-restricted diet on fat intake and serum lipid profiles. Although total fat intake did not change, we found a lower cholesterol intake and a higher polyunsaturated/saturated fat ratio in the patients with the protein-restricted diet. This is probably caused by the restriction of animal protein which results in the replacement of animal fat by vegetable fat in the protein-restricted group. Moreover, we observed an increase of plasma cholesterol and low-density lipoprotein cholesterol in patients with a normal protein intake which was absent in the protein-restricted group. This suggests a favourable effect of the institution of a protein-restricted diet on lipid intake and plasma profile.
