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Pleural effusion complicating acute peritoneal dialysis in hemolytic uremic syndrome
L Butani1, M S Polinsky, B A Kaiser
1Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134-1034, USA.
Insights
Pleural effusions (PE) are a complication of peritoneal dialysis (PD) in children with hemolytic uremic syndrome (HUS). Physicians should monitor for PE in HUS patients undergoing PD to prevent respiratory issues.
Area of Science:
- Pediatrics
- Nephrology
- Critical Care Medicine
Background:
- Hemolytic uremic syndrome (HUS) is a significant cause of acute renal failure (ARF) in children.
- Peritoneal dialysis (PD) is a common treatment for ARF, including that caused by HUS.
- Pleural effusions (PE) are a known, though infrequent, complication of PD.
Purpose of the Study:
- To investigate the incidence and characteristics of PE in pediatric patients with HUS undergoing PD.
- To compare the occurrence of PE in HUS patients versus non-HUS patients receiving PD for ARF.
Main Methods:
- Retrospective chart review of 176 children treated with PD for ARF between 1982 and 1996.
- Analysis of patient demographics, diagnosis (HUS vs. other causes of ARF), PD prescription, and development of PE.
- Comparison of PE incidence between HUS and non-HUS groups.
Main Results:
- Of 176 children receiving PD for ARF, 34 had HUS. Seven (20%) of the HUS patients developed PE, while none of the 142 non-HUS patients did.
- PE were diagnosed 1-3 days after initiating PD.
- Of the 7 affected children, 4 were managed with modified PD, 2 switched to hemodialysis, and 1 to continuous venovenous hemodiafiltration.
Conclusions:
- Pleural effusions appear to be a specific complication of PD in children with HUS.
- The exact mechanism of PE in HUS patients on PD remains unclear.
- Close monitoring for PE is recommended in pediatric HUS patients undergoing PD to mitigate risks of respiratory compromise.
Abstract:
Hemolytic uremic syndrome (HUS) is a leading cause of acute renal failure (ARF) in children, and one for which treatment with peritoneal dialysis (PD) is often necessary. Between January 1982 and December 1996, 176 children received PD for ARF at St. Christopher's Hospital for Children; 34 (19%) of whom had HUS. Of these 34, 7 (20%) developed pleural effusions (PE) while receiving PD, whereas none of the remaining 142 children with other causes of ARF did so. The mean age of the 7 affected children was 5.2 (range 0.4-17) years; none had heart failure or nephrotic syndrome, nor had any of them undergone thoracic surgery. PE were diagnosed by chest radiograph at an interval of 2 (range 1-3) days after starting PD. Thereafter, 4 (57%) patients were successfully maintained on a modified PD prescription; 2 others were converted to hemodialysis and 1 to continuous venovenous hemodiafiltration. Although PE are a known complication of PD, none of the patients so treated for non-HUS related ARF developed them. Whether they represent a purely mechanical complication of PD, or are in some way attributable to HUS itself, is not entirely clear. Regardless, when children with HUS require PD, physicians should monitor for the development of this potential complication to minimize the risk of serious respiratory compromise.