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The management of end-stage renal disease in infants with imperforate anus

A K Sharma1, C E Kashtan, T E Nevins

  • 1Department of Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis 55455.

Pediatric Nephrology (Berlin, Germany)
|December 1, 1993
PubMed

Insights

Infants with imperforate anus and end-stage renal disease (ESRD) can undergo successful dialysis and renal transplantation alongside staged bowel reconstruction. Careful management is crucial due to associated anomalies and long-term risks.

Area of Science:

  • Pediatric Surgery
  • Nephrology
  • Congenital Malformations

Background:

  • Genitourinary malformations often accompany imperforate anus, with renal failure causing mortality in up to 6% of supralevator cases.
  • Advances in renal transplantation and end-stage renal disease (ESRD) management now permit treatment for infants within their first two years of life.

Observation:

  • The feasibility of dialysis and renal transplantation in infants with imperforate anus and ESRD, considering the complexities of anorectal malformation repair, remains unclear.
  • This report details the care of three infants with imperforate anus and ESRD, focusing on initial surgical management, comprehensive malformation screening, ESRD treatment, and coordinated bowel reconstruction with renal transplantation.

Findings:

  • Successful management through coordinated dialysis, renal transplantation, and staged bowel reconstruction is achievable for infants with imperforate anus and ESRD.
  • These cases demonstrate the viability of intensive, multidisciplinary care for this complex patient population.

Implications:

  • Children with imperforate anus and ESRD can benefit from timely renal replacement therapy and surgical reconstruction.
  • Long-term considerations include risks associated with immunosuppression, potential bladder and bowel dysfunction, and management of co-existing congenital anomalies.

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