Comprehensive management of renal failure in infants

From 1986 through 1989, 23 infants (18 of whom were less than 30 days old) required peritoneal dialysis within their first 6 months of life. Modifications to conventional peritoneal dialysis included modified Silastic Tenckhoff catheters, peel-away sheaths for percutaneous insertion, automated peritoneal dialysis "cyclers," and generous omentectomy. With these modifications, there were no bowel perforations, and the infants were successfully dialyzed for prolonged periods. Eight of the 23 infants developed end-stage renal failure and were prepared for transplantation. All had gastrostomy tubes placed to supplement oral nutrition. Living, related transplantation was performed when the child weighted 10 kg. Four of the eight completed this protocol. One child with congenital nephrotic syndrome died before transplantation. One transplant was complicated by a technical problem (venous thrombosis), which resulted in allograft loss and return to peritoneal dialysis. Kidney function, growth, and development in the survivors were excellent.