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Severe hypertriglyceridemia in an infant on chronic hemodialysis
Rasha Aly1, Ratna Acharya2, Kiran K Upadhyay1
1Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
Insights
Severe hypertriglyceridemia can occur in infants with chronic kidney disease. A "milky layer" in hemodialysis may indicate this condition, requiring dietary management and lipid monitoring.
Area of Science:
- Pediatric Nephrology
- Clinical Biochemistry
Background:
- Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) face increased risks of developing hyperlipidemia.
- Hyperlipidemia, particularly severe hypertriglyceridemia, is a significant risk factor for cardiovascular disease (CVD).
Observation:
- A 7-month-old infant with Denys-Drash syndrome presented with a notable
- milky layer
- observed in the hemodialysis machine's deaerator.
- This visual finding prompted investigations into potential underlying metabolic abnormalities.
Findings:
- Investigations confirmed severe hypertriglyceridemia, with initial serum triglyceride levels exceeding 1000 mg/dL.
- The infant had transitioned from chronic peritoneal dialysis to hemodialysis prior to this observation.
Implications:
- Management strategies involved caloric intake reduction and the introduction of medium-chain triglycerides (MCTs).
- These interventions successfully lowered serum triglyceride levels to 300-400 mg/dL.
- The
- milky layer
- in hemodialysis may serve as a valuable early visual indicator of severe hypertriglyceridemia in pediatric patients, necessitating prompt lipid monitoring and intervention to prevent complications.
Abstract:
Severe hyperlipidemia is a risk factor for cardiovascular disease. Children with chronic kidney disease and end stage renal disease are at risk for development of hyperlipidemia. In this report, we describe a 7-month-old male infant with Denys-Drash syndrome who was found to have a "milky-layer" floating on the deaerator of the hemodialysis machine. Investigations showed severe hypertriglyceridemia of >1000 mg/dl. The patient had been on chronic continuous manual peritoneal dialysis until 6 months of age and recently had been switched to hemodialysis. Management included lowering of caloric intake and addition of medium chain triglyceride with reduction of the serum triglyceride levels to 300-400 mg/dl. Close monitoring of serum lipids and timely intervention is important to prevent serious complications associated with dyslipidemia. Observation of the "milky layer" in the deaerator of the hemodialysis machine may be an interesting visual clue of underlying severe hypertriglyceridemia.
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