Hanan Fathy

Pediatric Nephrology Unit

University of Alexandria
It is not Easy to Get Along that Early
without Kidneys
It is not Easy to Get Along that Early
without Kidneys
My first choice is….
• Bloxsum and Powell in 1948 and Swan and
Gordon in 1949, describe PD as a treatment option
for children with acute renal failure (ARF).

• 1961, Seger and colleagues reported the success of

pediatric PD for treatment of ARF, successful,
treatments were plagued with the repeated insertion
and removal of metal catheters.
• In 1968, Tenckhoff and Schecter introduced a safe
and permanent catheter which revived interest in
PD.

• The first reported use of CAPD in a child was in

Toronto in 1978.
Peritoneal dialysis unit at AUCH
• 1985 peritoneal dialysis unit was established
in pediatric department, university of
Alexandria.

• Before hands infants with renal failure were

treated on conservative non dialytic basis ????
• From the year 1985 to 2009 the pediatric
nephrology unit received and treated 936
cases of acute renal failure of which 93% of
them as modality of dialysis of choice to initiate
dialysis .
 Demographic data of our cases
Distribution of cases according to their age

400
350
300
250
N o. of cases 200
150
100
50
0
Neonate infant preschool school adolescent
 Distribution of cases as regards
place of referral
450

400

350
cases from out side
the hospital 300
Hospital acquired
250

ICU 200

150
NICU
100

50

0
 Clinical presentation of cases of ARF

90
80
70 V. overload %
60 Hypertension %
50 Heart failure %
40 GIT. Bleeding %
30 Bl. Diasthesis %
Convulsions %
20
Coma %
10
0
presentation
Type of dialysis done for cases
with ARF

6% 1%
Peritoneal dialysis

Peritoneal/hemodialysis

Hemodialysis

93%
 Diagnosis of cases dialyzed
for ARF
Acutetubular /cortical necrosis

Acuteontopof chronicrenal failure

Obstructive /reflux nephropathy

HUS

Congenital anomaly
Nephrotic syndrome

Unknown

RapidlyprogressiveGN
Bilateral nephrolithiasis

Tumour lysis syndrome

SLE

Hepatorenal syndrome
Juvenile /familial nephronophthisis

Bilateral polycystic kidney

Renal tumour

Uricacidnephropathy

Acuteinterstitial nephritis
Alport syndrome

Nephrocalcinosis
Renal trauma /nephrectomy
Fate of cases dialyzed for ARF

3 1.1%
d ie d 3 9.7%
c h ro n i c
fo l l o w u p

2 9.2%
 Morbidity and mortality of cases
with ARF regarding place of
referral .
100

90
 
80

cases from out side 70

the hospital
60
Hospital acquired
% 50
PICU
40

NICU 30

20

10

0
Follow up % Died % Chronic %
 as
Fate of cases dialyzed for ARF
regards different age groups
100

90

80

70

60

Follow up %
% 50
Died %
Chronic % 40

30

20

10

0
Neonate Infant Preschool School Adolescent
 Modality of chronic renal
replacement therapy for chronic
cases

PD
40%
HD
PD
HD
60%
 Reasons for Change of Dialysis
Modality
PD HD

50

40

30

20
Percent

10

Excessive Family Access Inadequate Other

Infection Choice Failure UF/Clearance
• Since the unit was established we hosted
50 cases of chronic renal failure who
were on intermittent peritoneal dialysis
(IPD) 3times /week keeping our unit
always a BUSY unit.

• Ten cases of patients being dialyzed for

chronic renal failure via peritoneal
dialysis were referrals from NICU
 CAPD
• Besides cases being dialyzed in the hospital, we
are encouraging mother to adapt CAPD , being a
better and more physiologic modality of dialysis.

• OUR unit a 10 years period was responsible for 15

cases of CAPD of different age groups, one of
them completed her high school and entered the
collage
 Training for Home PD
we always see for:
• Training by QUALIFIED children’s nurse
• Two family members (which can include patient)
to be trained
• Home adaptations should have been made
• Equipment must meet SAFETY standards and
technical support must be available
 STARTING AND SUSTAINING

CHRONIC PERITONEAL DIALYSIS

Requires

PARTNERSHIP BETWEEN

FAMILY, HOSPITAL and

COMMUNITY TEAMS
Dialysis is neither the perfect
nor the happy end
 This patient is being dialyzed
ever since he was 10 days old!
Changed 4 PPC due to infection and obstruction
He is now 8 years old weighting
6 Kg and measuring 75 cm