RESUMO
We retrospectively analysed peritoneal dialysis treatment in 29 infants dialysed in 9 paediatric centres in Poland in the years 1993-2004. The mean age at the start of dialysis was 4.9 +/- 3.5 months (range 2 days to 11 months), mean body mass 5.6 +/- 2.5 kg (range 2.5 to 11 kg). The mean duration of PD was 6.8 +/- 3.9 in the first year of life and total duration of the therapy 34 +/- 27 months. Of the 29 infants 4 died (2 in infancy), 11 underwent renal transplantation, in 2 children PD was stopped (they received a conventional treatment) and 12 were still dialysed at the date of data collection. The peritonitis rate was 1/9.5 patient-month and exit site infection rate 1/16 patient-month up to 1 year of life. 9 children (31%) required hernia repairs and in 9 catheters were replaced. Chronic peritoneal dialysis in infants is associated with high risk of infections and surgical complications and remains a challenge for paediatric nephrologists.
Assuntos
Infecções/epidemiologia , Diálise Peritoneal/estatística & dados numéricos , Peritonite/epidemiologia , Peritonite/terapia , Causalidade , Comorbidade , Hérnia/epidemiologia , Humanos , Lactente , Recém-Nascido , Polônia/epidemiologia , Vigilância da População , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Ostitis in the course of secondary hyperparathyroidism can lead to heavy atypical skeletal changes. In 4-year old girl on hemodialysis, with hyperparathyroidism (iPTH level > 1500 pg/ml), despite specific pharmacological treatment, very pronounced skull and maxillary bone malformations developed within two months, which were the cause of problems with breathing. We observed also growing bones malformations concerning arms, legs, vertebral column and pelvis. Severe infectious ostitis with severe uremic osteodystrophy was diagnosed. After 3 months of antibiotic treatment (clindamycin) subtotal parathyreidectomy was performed. Control iPTH level was 111 pg/ml. In next weeks skull skeletal changes partially resolved, which was confirmed on computer tomography, and patients general condition improved. She has no longer difficulties with breathing.
