Nurse Practitioner Paediatric Nephrology
Renal Treatment Centre
Children's Hospital Westmead
Early transplantation in a small anuric infant on dialysis
Jill Farquhar1, Deirdre Hahn1.
1Nephrology, Sydney Childrens Hospital Network-Westmead, Westmead. NSW., Australia
Introduction: Recent data suggests children with chronic kidney disease may have low-average cognition compared with their normal peers, and poor outcomes such as malnutrition and failure to attain developmental milestones are frequently observed in infants undergoing dialysis.
The policy in a majority of Australian paediatric transplant units is to withhold renal transplant until a minimum weight of 10 kilogram is reached due to the reno-vascular technical difficulties of transplanting an adult kidney into an infant. In view of this policy, the decision to commence renal replacement therapy for infants less than twelve months of age is often the topic of ethical debate.
Methods: We present a case report of a female infant who presented in ESKD age eleven months, weighing 5.8kg and length 67cm. The infant was anuric and was initially treated with continuous veno-veno haemofiltration and intermittent haemodialysis for three weeks, prior to converting to automated peritoneal dialysis.
After six months of dialysis she had poor weight gain and poor progress in developmental milestones. The infant developed fluid overload, hypertension and suffered temporary paralysis after a water shed incident. Following discussion with the transplant surgical team, a formal submission was made to the New South Wales Transplant Advisory Committee requesting the child be placed on a priority transplant waiting list with a donor size of 30kg or less. Four months later, the infant received a renal transplant from a 12 kilogram paediatric donor.
Results: Eleven months after renal transplantation, now aged 2 years, this patient weighs 10 kilograms, and has attained height 78.9cm. She is progressing well developmentally, with marked improvement in developmental scores, and in particular a gross motor score increase from 4 to 8.
Conclusion: We believe urgent renal transplantation with small donor for small children may be advised as an alternate method of therapy for high risk infants receiving dialysis.
18:30 - 19:30
|Poster Session 2||Early transplantation in a small anuric infant on dialysis||Exhibit-Poster Area|