Management of a child on CAPD with a ventriculoperitoneal shunt

Long term dialysis in children with multiple handicaps has become easier with the advent of CAPD. In December 1986, an 11 year old with myelomeningocele in end stage renal disease secondary to chronic pyelonephritis required dialysis. Placement of a right ventriculoperitoneal shunt had been done at 4 months of age. Poor family compliance required placement in medical foster care. The peritoneal catheter was replaced three times. Leakage and infection were the major complications resulting in catheter replacement. In March 1988 the child required shunt extension due to accelerated growth after which she developed relapsing peritonitis requiring removal of the peritoneal catheter and externalization of the ventriculoperitoneal shunt. A proximal tap of the ventriculoperitoneal shunt prior to revision had a negative culture but glucose of 471 when serum glucose was 91. Six days after externalization of the shunt and catheter removal, the shunt was converted to ventriculoatrial and the PD catheter replaced. Nasogastic feedings and cycler dialysis became necessary due to worsening nutritional status and hyperabsorption. Successful transplantation occurred 28 months after initial dialysis.