ABSTRACT
The rate of peritonitis, its etiology and efficacy of treatment was compared between 28 children treated with APD for a total of 439 dialysis months and 24 children on CAPD treated for 328 dialysis months. The peritonitis rate was significantly lower in children on APD (1 episode per 27 months) than in children on CAPD (1 episode per 17 months) (p = 0.005). The etiology of peritonitis (68% v. 62% Gram + organisms), efficacy of treatment (100% v. 100%) and relapse rate did not differ between the machine operated and manual methods of peritoneal dialysis.
Subject(s)
Peritoneal Dialysis/methods , Peritonitis/therapy , Adult , Child , Child, Preschool , Female , Gram-Positive Bacteria/isolation & purification , Humans , Incidence , Infant , Male , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis/epidemiology , Peritonitis/microbiology , Poland/epidemiology , RecurrenceABSTRACT
Bilateral hydrothorax is a very rare complication of ambulatory peritoneal dialysis in children. We present a case of a 13-year-old girl who developed bilateral acute hydrothorax during after seven months of CCPD. Peritoneal dialysis was temporarily discontinued and the child was transferred to haemodialysis. Six weeks later the patient was successfully resumed CCPD.
Subject(s)
Hydrothorax/etiology , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Adolescent , Female , Humans , Renal DialysisABSTRACT
Hypertension is one of the main risk factors of mortality for children on renal replacement therapy. It has also been recognised as one of the major risk factors for progression of renal failure. The aim of the study was to define the prevalence of hypertension in children with chronic renal failure, treated in a single centre, and to assess the efficacy of its diagnosis and management. Hypertension was present in 27% of 40 children before the onset of chronic renal failure, increasing to 57% with the development of CRF, and reaching 86% at onset of dialysis. Reflux nephropathy, hemolytic-uraemic syndrome and glomerular disease were most frequently associated with severe hypertension. ACE inhibitors (70%), diuretics (52%), and calcium channel blockers were the most frequently used antihypertensives with 49% of the children being on monotherapy. Despite therapy 43% of children had elevated blood pressure levels and 16% had echocardiographic signs of LVH. A 24 hour ambulatory blood pressure measurements were more sensitive in diagnosing hypertension and assessing adequacy of blood pressure control. Early and intensified treatment should prevent end organ damage though optimal blood pressure values to aim obtain are still to be defined.
Subject(s)
Hypertension/complications , Hypertension/epidemiology , Kidney Failure, Chronic/complications , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , PrevalenceABSTRACT
Haematuria is a typical symptom of glomerular involvement in Henoch-Schoenlein syndrome in children. The authors present an unusual case of haematuria and deterioration of renal function caused by cystine stones in a child with anaphylactic purpura. This 6 year old girl was hospitalized because of severe gastrointestinal symptoms in the course of a typical Henoch-Schoenlein syndrome. After 4 weeks of illness--the child demonstrated haematuria and oliguria with severe loin pain and a rise in serum creatinine to 5.8 mg%. Urine findings of mainly non-glomerular erythrocytes and slight proteinuria were suggestive of a non-glomerular cause of renal failure. Ultrasound examination revealed the unexpected finding of bilateral kidney obstruction caused by multiple renal stones. Cystine crystals observed under microscopic examination of the urinary sediment and a positive cyanide-nitroprusside test suggested cystinuria as the cause of nephrolithiasis. High water intake and alkalization of urine and captopril for cystine excretion reduction resulted in fast improvement of renal function and and with time complete dissolution of calculi. The symptoms of Henoch-Schoenlein syndrome resolved over several weeks, and the child did not develop any signs of glomerular involvement.
Subject(s)
Cystinuria/complications , Hematuria/etiology , IgA Vasculitis/complications , Kidney Calculi/etiology , Renal Insufficiency/complications , Acute Disease , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Captopril/therapeutic use , Child , Cystinuria/therapy , Drinking , Female , HumansABSTRACT
Ultrasound diagnosis of catheter related infections in patients on peritoneal dialysis is easy to perform diagnostic procedure which enables more precise diagnosis and better follow-up of therapy. The authors present three cases of exit site and tunnel infections in children, illustrating the value of ultrasound evaluation in their diagnosis and in decisions on conservative treatment or catheter removal.
