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Dialysis and renal transplantation in infants with irreversible renal failure
1Johns Hopkins School of Medicine, Baltimore, MD 21287-2535, USA.
Insights
Infants with end-stage renal disease now have successful treatment options like dialysis and transplantation. This report details practical guidelines for managing these young patients, addressing nutrition, development, and immune system factors.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Infants with irreversible renal failure historically had poor outcomes.
- Aggressive medical intervention was previously deemed futile for this population.
Purpose of the Study:
- To provide practical guidelines for managing infants with end-stage renal disease.
- To discuss patient care issues, including nutritional and neurodevelopmental aspects.
- To present technical considerations for dialysis and transplantation in infants.
Main Methods:
- Review of current clinical experience and technical advances in pediatric renal replacement therapy.
- Discussion of specific challenges in infant care, such as nutritional needs and neurodevelopmental monitoring.
- Presentation of surgical and procedural considerations for peritoneal dialysis, hemodialysis, and renal transplantation in neonates and infants.
Main Results:
- Dialysis and transplantation are now viable and successful therapeutic options for infants with end-stage renal disease.
- Advances in technology and clinical practice have improved outcomes for this patient group.
- Key areas of focus include optimizing nutrition, monitoring neurodevelopment, and managing immune system alterations.
Conclusions:
- The management of end-stage renal disease in infants has significantly evolved, offering improved therapeutic possibilities.
- Comprehensive care strategies are essential, encompassing medical, surgical, nutritional, and developmental support.
- Continued clinical experience and technical refinement are crucial for optimizing outcomes in pediatric renal replacement therapy.
Abstract:
Historically, infants with irreversible renal failure fared poorly, and aggressive medical intervention was considered futile. Although the care of this population clearly remains a challenge, technical advances and clinical experience have now made dialysis and transplantation reasonable and successful therapeutic options. This report provides a discussion of practical guidelines and patient care issues particular to the infant with end-stage renal disease. Topics addressed include nutritional requirements, neurodevelopmental abnormalities, and the possible contribution of alterations of the immune system to patient morbidity. Specific technical considerations for the performance of peritoneal dialysis, hemodialysis, and transplantation in the very small infant are also presented.