Paediatric renal failure Flashcards
What are pre-renal causes of acute renal failure
Hypovolaemia - fluid loss, dehydration, 3rd space lost
What are renal causes of acute renal failure
Haemolytic uraemic syndrome Anaemia (haemolysis) Thrombocytopaenia Uraemia E Coli 0157 - through diet or touching animals
What are post renal causes of acute renal failure
Obstruction - abdominal masses, renal tumours, constipation
End stage renal failure is (common/uncommon/never happens) in children
Uncommon
What can cause ESFR in children
Structural abnormalities
Nephritis
Haemolytic uraemic syndrome
How might ESFR present in paediatrics
Anorexia
Poor growth
Hypertension
Can present as an emergency
Most children will receive a transplant before needing dialysis (T/F)
False, some children may have a pre-emptive transplant, but most start of dialysis
What types of dialysis are available
Peritoneal dialysis
Haemodialysis
What proportion of children needing dialysis will have peritoneal dialysis
2/3
Peritoneal dialysis requires trips to the hospital T/F
False
Can be done at home but requires in dwelling peritoneal catheter
What modes of peritoneal dialysis are there?
Overnight cycling - 12 hours on 12 hours off
Continuous ambulatory - small volume, continuous fills
Which mode of peritoneal dialysis is better for older children
Continuous ambulatory - less disturbance of lifestyle
What are the potential complications of peritoneal dialysis
Peritonitis Hernia Catheter blockage Tunnel infections Ommental blockage Parental stress/burnout
What is the minimum weight required for haemodialysis
10 kg
What is the typical regime for haemodialysis
4 hours 3 sessions/week
What access is required for haemodialysis
Indwelling catheter
or
Fistula
For whom might home haemodialysis be viable
Older children with highly motivated families
What percentage of children have a relative who can donate a kidney?
25%
What is the donor mortality rate?
0.03%
How long will it take for a donor to recover?
3 months although their lifetime risk of ESRF will remain slightly elevated
What is the age range of donors for a paediatric transplant
5-55
What is a common condition that can complicate renal transplant if present in the donor and why?
Hypertension
Children already have a lower BP than adults, so a hypertensive kidney would be too much of a jump
What aspects of the history would cause a kidney donor to be rejected?
Malignancy or blood bourne viruses
Why might a child with mixed heritage be given a sub-optimal kidney whilst a white child with British heritage would wait for a near-perfect match?
The donor pool is much larger for the white child, so more likely to get a good transplant
The mixed heritage causes a complex immunological profile, so may not find a good match in time
What is the Z score
Used to match kidney to recipient based on degree of match
What results in a better quality of life, with reduced mortality and morbidity?
Dialysis / Transplant
Transplant
What complications can arise from kidney transplant?
Immediate perioperative complications Drug side effects Immunosupression Acute rejection Chronic rejection Recurrence of underlying renal disease Post transplant lymphoproliferative disease (PTLD)
What causes PTLD
It is an EBV driven malignancy
What is the 5 year graft survival rate from a living donor
87%
What is the 7 year graft survival rate from a living donor
73%
What is the 10 year graft survival rate from a living donor
60%
What is the 5 year graft survival rate from a deceased donor
76%
What is the 7 year graft survival rate from a deceased donor
60%
What is the 10 year graft survival rate from a deceased donor
50%
When does the incidence of graft loss peak?
Adolescence and early adulthood due to compliance and rapid growth
