Monday, February 12, 2007

Kidney Failure and Peritoneal Dialysis in Children

As metabolic rate in children is fast it results in accumulation of solutes which the damaged kidney’s cannot handle. Growth and intellectual development in children stops and slows down. This leads to imbalance of endocrine function. It is very difficult to achieve successful dialysis in children, there has been progress witnessed in renal Replacement Therapy in Children.

End Stage Renal Disease in Children are small fraction of total End Stage Renal Patients. The causes of ESRD in Children can be attributed to Hereditary Renal Disorder and Renal Lesion. The same can be divided into 50:50 %. Whereas in adults it almost 80% of the disease is attributed as acquired renal disease.

Peritoneal Dialysis in Children:

The Membrane of Peritoneum of child is functionally different from that of adult and Peritoneal transport change as per normal growth and development. The study of peritoneal surface area in Children and Adult was carried out and was found that Peritoneal Surface Area of is almost twice that of Adult as per Putiloff whereas Wegner suggestion that Peritoneal Surface Area approximated to Body Surface Area in Adults. According to Mass-Transfer Area Co-efficients (MTAC) for various solutes Peritoneal Solute transfer in children can be characterized.

It was also found that MTACs for Urea, Uric Acid and Creatinine and Glucose was similar to adult reference values. Protein levels were found higher in children then adult reference values. Conclusively, only peritoneal transfer of protein is demonstrated as age dependent, beyond neonatal period. Also to state that adequate fluid transfer is difficult to be achieved in infants and younger children. The fluid Transfer problems were observed due to fast decline of dextrose concentration. The patient’s peritoneal membrane transport functions can be compared to population norms by Peritoneal Equilibrium Test.

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