[A child with myelomeningocele as a dialytic patient].
The aim of the study was to present difficulties and problems of dialytic treatment in children with spina bifida (SB). Between 2000 and 2005 five girls with SB and neurogenic bladder were treated with renal replacement therapy (15% of all children with end stage kidney disease dialyzed at our centre). Four patients (pts) had hydrocephalus requiring ventriculoperitoneal shunt, they were wheelchair-bound due to lower limbs paralysis and mentally retarded. Only 1 girl had been supervised by nephrologist from the very beginning. Dialysis was started at the age of 3-17 yr and the first mode was automatic peritoneal dialysis (ADO) in 3 and hemodialysis (HD) in 2. During the treatment ADO was switched onto HD in 2 pts for sclerosing encapsulating peritonitis (1) and tunnel infection with spontaneous Tenckhoff catheter evacuation (1). Permanent central venous catheters served as vascular access in 3 cases, in 2 there were difficulties with creation of arteriovenous fistula. No neurological complications were noticed in pts with ventriculo-peritoneal shunt and ADO. Total period of renal replacement therapy was 9-99 mo. Only 2 pts were qualified to transplantation. Two pts died after 16 mo of dialysis, 2 were transplanted and 1 is still being treated with HD. All families were dysfunctional. In 4 cases insufficient parental support caused many disturbances during predialytic and dialytic period. We concluded that in Poland pediatric pts with SB create specific group with the number of problems and complications higher than in other children on dialysis.
Jachimiak
Bozena
B
Oddział Nefrologii ze Stacja Dializ, Specjalistyczny Samodzielny Publiczny, Zakład Opieki Zdrowotnej nad Dzieckiem i Młodzieza w Szczecinie. pednefrolszczecin@wp.pl
Jarmoliński
Tomasz
T
D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000592:standards*; D016135:Spinal Dysraphism / Q000150:complications*; D017211:Treatment Failure; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000628:therapy*