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https://www.readbyqxmd.com/read/27843077/renal-replacement-therapies-in-neonates-issues-and-ethics
#1
REVIEW
Lesley Rees
Chronic irreversible kidney disease requiring dialysis is rare in the neonate. Many such neonates are diagnosed following antenatal ultrasound with congenital abnormalities of the kidneys and urinary tract. There is an increased incidence of prematurity and infants that are small for gestational age. Given the natural improvement in renal function that occurs in the neonatal period, some with extremely poor renal function may, with careful management of fluid and electrolytes, be kept off dialysis until the creatinine reaches a nadir when a definitive plan can be made...
November 11, 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27796620/peritoneal-dialysis-for-the-management-of-pediatric-patients-with-acute-kidney-injury
#2
Anil Vasudevan, Kishore Phadke, Hui-Kim Yap
Renal replacement therapy (RRT) is the most important supportive measure used in the management of acute kidney injury (AKI). Peritoneal dialysis (PD) is a safe, simple and inexpensive procedure and has been used in pediatric AKI patients, ranging from neonates to adolescents. It is the modality of choice for RRT in developing countries with cost constraints and limited resources. However, its use has declined with the availability of newer types of extracorporeal modalities for RRT in the developed world. Much controversy exists regarding the dosing and adequacy of PD in the management of AKI...
October 28, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27733241/chronic-kidney-disease-in-the-neonate-etiologies-management-and%C3%A2-outcomes
#3
Jason Misurac
Neonatal chronic kidney disease (CKD) occurs with an estimated incidence of 1 in 10,000 live births, whereas the incidence of neonatal end-stage renal disease (ESRD) is about 7.1 per million age-related population. The most frequent etiologies are renal hypoplasia/dysplasia, posterior urethral valves, and other congenital anomalies of the kidney and urinary tract. Other etiologies include polycystic kidney disease, cortical necrosis, and renal vascular thrombosis. Management of CKD focuses primarily on replacing renal functions such as erythropoietin, 1,25-hydroxylation of vitamin D, electrolyte homeostasis/excretion, and, in ESRD, waste product removal...
October 9, 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27682213/the-management-of-neonatal-acute-and-chronic-renal-failure-a-review
#4
Malcolm G Coulthard
Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure...
September 25, 2016: Early Human Development
https://www.readbyqxmd.com/read/27512461/chronic-kidney-disease-in-pregnancy-maternal-and-fetal-outcomes-and-progression-of-kidney-disease
#5
Natalie L Davidson, Penny Wolski, Leonie K Callaway, Helen L Barrett, Narelle Fagermo, Karin Lust, Rebekah E Shakhovskoy
BACKGROUND: There is a paucity of Australian data regarding renal disease in pregnancy. We undertook a retrospective cohort study at a tertiary institution to examine the impact of renal disease on pregnancy outcomes and the effect of pregnancy on disease progression. METHODS: A total of 55 pregnancies of patients with renal disease admitted from 2003 to 2010 to the Royal Brisbane and Women's Hospital were analysed. Pre-conception variables, fetal/delivery and maternal outcomes were analysed in this group and in a control group of women with normal kidney function pre-pregnancy...
June 2015: Obstetric Medicine
https://www.readbyqxmd.com/read/27467564/severe-congenital-anomalies-of-the-kidney-and-urinary-tract-epidemiology-can-inform-ethical-decision-making
#6
P Danziger, D R Berman, K Luckritz, K Arbour, N Laventhal
OBJECTIVE: Decision-making for pregnancies complicated by severe congenital anomalies of the kidneys and urinary tract (CAKUT) are ethically challenging, partly because the outcomes are not well studied. STUDY DESIGN: Retrospective cohort study of severe cases of CAKUT over 14 years. RESULTS: Seventy-one of the 108 cases could be completely analyzed. Forty-six percent (n=33) infants were live-born; one-third (n=11) survived to 12 months. Twice as many non-surviving infants received a trial of therapy vs comfort care only...
July 28, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27451865/outcome-assessment-of-renal-replacement-therapy-in-neonates
#7
Ilan I Maizlin, Michelle C Shroyer, Lena Perger, Mike K Chen, Elizabeth A Beierle, Colin A Martin, Scott A Anderson, Vincent E Mortellaro, David A Rogers, Robert T Russell
BACKGROUND: Recent advances in renal replacement therapy (RRT) have brought about a proliferation of dialysis in neonates (<30 d). This study aimed to assess morbidity and mortality after RRT initiation in this population. METHODS: Retrospective chart review of all patients between 2006 and 2014 requiring RRT initiated in the first 30 d of life was performed. RESULTS: A total of 49 patients were identified, of which 39 were boys and 10 were girls...
July 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27401742/posterior-urethral-valves-are-neonatal-imaging-findings-predictive-of-renal-function-during-early-childhood
#8
Véronique Hochart, Annie Lahoche, René-Hilaire Priso, Véronique Houfflin-Debarge, Alfred Bassil, Dyuti Sharma, Hélène Behal, Freddy Efraim Avni
BACKGROUND: Obstructive renal dysplasia as observed on US is associated with posterior urethral valves and is regarded as predicting poor renal functional outcome. OBJECTIVE: To investigate whether any characteristic of urinary tract imaging at birth is predictive of renal function in children with prenatally diagnosed posterior urethral valves. MATERIALS AND METHODS: We reviewed clinical data including renal function (at birth and up to 3 years of age) and clinical outcome (urinary infection, dialysis, renal transplantation)...
September 2016: Pediatric Radiology
https://www.readbyqxmd.com/read/27366662/the-successful-clinical-outcomes-of-pregnant-women-with-advanced-chronic-kidney-disease
#9
Ji-Yeun Chang, Hanbeol Jang, Byung Ha Chung, Young-Ah Youn, In-Kyung Sung, Yong-Soo Kim, Chul Woo Yang
BACKGROUND: Successful pregnancy outcomes in patients with advanced chronic kidney disease (CKD) are increasingly common in Western countries. However, in Korea, the available literature addressing this clinical issue is scarce. METHODS: We reviewed 5 successful parturitions [1 patient with Stage 5 CKD and 4 with maintenance hemodialysis (HD)] at Seoul St. Mary's Hospital over 3 years and investigated changes in dialysis prescription, anemia management, and the incidence of maternal and neonatal complications...
June 2016: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/27270721/neonatal-extracorporeal-renal-replacement-therapy-a-routine-renal-support-modality
#10
EDITORIAL
Leyat Tal, Joseph R Angelo, Ayse Akcan-Arikan
Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27216547/survival-of-a-very-low-birthweight-infant-with-potter-sequence-on-long-term-hemodialysis
#11
Jun Miyahara, Masaki Yamamoto, Kyoko Motoshige, Naoya Fujita, Shigeru Ohki
Recent advances in neonatal cardiorespiratory management and neonatal renal replacement therapy have led to occasional reports of favorable short-term and long-term outcomes for Potter sequence, once thought to be fatal. The present patient was a girl born at a gestational age of 34 weeks 4 days with a birthweight of 1398 g. She was diagnosed with Potter sequence complicated by pulmonary hypoplasia due to left renal agenesis and small right kidney. Hemodialysis was started because anuria persisted even after persistent pulmonary hypertension receded and cardiorespiratory status improved...
July 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/27197910/the-role-of-rrt-in-hyperammonemic-patients
#12
Shruti Gupta, Andrew Z Fenves, Robert Hootkins
Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body's own mechanisms for clearing ammonia as well as the dialytic properties of ammonia...
May 19, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27187531/extracorporeal-membrane-oxygenation-for-pediatric-respiratory-failure-risk-factors-associated-with-center-volume-and-mortality
#13
Brandon W Kirkland, Jacob Wilkes, David K Bailly, Susan L Bratton
OBJECTIVES: Recent analyses show higher mortality at low-volume centers providing extracorporeal membrane oxygenation. We sought to identify factors associated with center volume and mortality to explain survival differences and identify areas for improvement. DESIGN: Retrospective cohort study. SETTING: Patients admitted to children's hospitals in the Pediatric Health Information System database and supported with extracorporeal membrane oxygenation for respiratory failure from 2003 to 2014...
August 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27174514/outcomes-of-neonates-requiring-prolonged-stay-in-the-intensive-care-unit-after-surgical-repair-of-congenital-heart-disease
#14
Makoto Mori, Courtney McCracken, Kevin Maher, Brian Kogon, William Mahle, Kirk Kanter, Bahaaldin Alsoufi
OBJECTIVE: After neonatal cardiac surgery, a number of patients need a prolonged stay in the intensive care unit (ICU). Those patients require tremendous resources and strain the capacity of cardiac units. To date, little knowledge of early and late survival for this challenging population exists. METHODS: From 2002 to 2012, 108 neonates required a postoperative ICU stay >30 days. Multivariable regression analyses examined factors associated with hospital death and late survival...
September 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27139897/cvvhd-treatment-with-carpediem-small-solute-clearance-at-different-blood-and-dialysate-flows-with-three-different-surface-area-filter-configurations
#15
Anna Lorenzin, Francesco Garzotto, Alberta Alghisi, Mauro Neri, Dario Galeano, Stefania Aresu, Antonello Pani, Enrico Vidal, Zaccaroa Ricci, Luisa Murer, Stuart L Goldstein, Claudio Ronco
BACKGROUND: The CARdiorenal PEDIatric EMergency (CARPEDIEM) machine was originally designed to perform only continuous venovenous hemofiltration (CVVH) in neonatal and pediatric patients. In some cases, adequate convective clearance may not be reached because of a limited blood flow. In such conditions, the application of diffusive clearance [continuous venovenous hemodialysis (CVVHD)] would help optimize blood purification. In this study, the CARPEDIEM™ machine was modified to enable the circulation of dialysis through the filter allowing testing of the performance of CARPEDIEM™ machine in CVVHD...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27130041/a-novel-lamb2-gene-mutation-associated-with-a-severe-phenotype-in-a-neonate-with-pierson-syndrome
#16
Boutaina Zemrani, François Cachat, Olivier Bonny, Eric Giannoni, Jacques Durig, Florence Fellmann, Hassib Chehade
BACKGROUND: Pierson syndrome (PS) is a rare autosomal recessive disorder, caused by mutations in the laminin β2 (LAMB2) gene. It is characterized by congenital nephrotic syndrome, microcoria, and neurodevelopmental deficits. Several mutations with genotype-phenotype correlations have been reported, often with great clinical variability. We hereby report a novel homozygous nonsense mutation in the LAMB2 gene, associated with a severe phenotype presentation. CASE DIAGNOSIS: We describe a term male infant born from consanguineous parents...
2016: European Journal of Medical Research
https://www.readbyqxmd.com/read/27121012/the-use-of-acute-peritoneal-dialysis-in-critically-ill-newborns
#17
Lokman Ustyol, Erdal Peker, Nihat Demir, Kemal Agengin, Oguz Tuncer
BACKGROUND To evaluate the efficacy, complications, and mortality rate of acute peritoneal dialysis (APD) in critically ill newborns. MATERIAL AND METHODS The study included 31 newborns treated in our center between May 2012 and December 2014. RESULTS The mean birth weight, duration of peritoneal dialysis, and gestational age of the patients were determined as 2155.2 ± 032.2 g (580-3900 g), 4 days (1-20 days), and 34 weeks (24-40 weeks), respectively. The main reasons for APD were sepsis (35.5%), postoperative cardiac surgery (16%), hypoxic ischemic encephalopathy (13%), salting of the newborn (9...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27110021/successful-pregnancies-in-kidney-transplant-recipients-experience-of-the-national-kidney-transplant-program-from-uruguay
#18
S Orihuela, M Nin, S San Román, O Noboa, L Curi, R Silvariño, F González-Martínez
BACKGROUND: Renal transplantation increases the possibilities of pregnancy in women of reproductive age. The course of pregnancy was analyzed retrospectively in patients with kidney or kidney-pancreas transplant, surveying maternal-fetal or renal graft complications and the relation with pre-pregnancy renal function. METHODS: A cohort that includes all the kidney transplant recipients who went through pregnancy in Uruguay in a period of 28 years is described. Forty pregnancies in 32 patients were registered; the average time between the kidney transplant and the beginning of the gestation period was 47 months...
March 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27061443/intensive-dialysis-and-pregnancy
#19
REVIEW
Michelle Hladunewich, Dori Schatell
Pregnancy in women with end stage renal disease on renal replacement therapy is uncommon due to the physiologic changes associated with renal failure as well as the complexities and risk involved in managing these patients. As most of these women had long periods of illness with chronic kidney disease, the effects of their chronic illness together with the current societal trends to delay child bearing to a more advanced maternal age can hamper fertility. For those able to conceive, intensified hemodialysis (HD), through longer and/or more frequent dialysis sessions, offers improved maternal and neonatal outcomes...
July 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27037272/update-on-ethical-issues-in-pediatric-dialysis-has-pediatric-dialysis-become-morally-obligatory
#20
Aaron G Wightman, Michael A Freeman
Improvements in pediatric dialysis over the past 50 years have made the decision to proceed with dialysis straightforward for the majority of pediatric patients. For certain groups, however, such as children with multiple comorbid conditions, children and families with few social and economic resources, and neonates and infants, the decision of whether to proceed with dialysis remains much more controversial. In this review, we will examine the best available data regarding the outcomes of dialysis in these populations and analyze the important ethical considerations that should guide decisions regarding dialysis for these patients...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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