Case Report of Renal Replacement Therapy in a 1 Year-Old Patient with Aki

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CASE REPORT OF RENAL REPLACEMENT THERAPY IN A 1 YEAR-OLD PATIENT WITH AKI

Castillo G, Cepeda M, Restrepo J

Fundación Valle del Lili, Universidad CES. Cali – Colombia.

Introduction

Renal replacement therapy in children is a rare event, but with important implications for morbidity and mortality in this age group. Although the incidence of children with kidney failure is relatively low and patients requiring renal replacement therapy are usually few in these, has been recognized the significant positive impact on early recognition of children who require and implement of adequate therapy. According to the annual report of the UK Renal Registry, during 2009 there were 751 children with established renal injury receiving renal replacement therapy.

Objective

We report a case of a patient who required renal replacement therapy secondary to a procedure-related multi-organ failure.

Results

The patient was referred from a peripheral centre of care with a diagnosis of septic shock of abdominal origin, multiorgan failure, acute renal injury, post- laparotomy for correction of intestinal mal-rotation, intestinal obstruction and release of congenital constricting bands and syndrome post-resuscitation. The patient was hospitalized in the Pediatric Intensive Care Unit (PICU). The principal clinical of the patient consisted in 6 days of intestinal obstruction, secondary to constricting bands and intestinal mal-rotation. In the course of corrective surgery, the patient presented cardio-respiratory failure accompanied by renal failure, and was referred to institution. To acute renal injury management we used renal replacement therapy with continuous veno-venous hemofiltration (CVVHF) for five days, then started continuous infusion of furosemide in which there was no improvement, which required restarting CVVHF for 18 days and hemodiafiltration with pump flow to 100ml/min with fluid loss of 150 ml/h. Renal function recovery was obtained after 30-days of management. As a related complication, blow up of catheter and filter plugging occurred. After a 30-days hospitalization, the patient was discharged with additional diagnosis of postoperative of severe pneumonia and acute respiratory distress syndrome, septic shock refractory to inotropic fungemia resolved, myocardial dysfunction, renal dysfunction and acute renal injury.

Conclusions

Acute renal injury is a condition that quickly complicated pediatric patient, sepsis remains the leading cause of the complication reported in multiple series. Previous reports have shown the advantage of starting early RRT patients with a significant favorable impact in patients with sepsis and multi-organic failure.

Hemofiltration in septic patients is a good strategy, that removes efficiently the pro-inflammatory substances from the blood torrent due to their major inflammatory reaction, by its mechanism of convection, more sensible than standar dialysis, thereby limiting systemic damage.

References

1.  Gulati A et al. Management of Acute Failure in the Pediatricintensive Care Unit. Indian J Peadiatric. 2010

2.  Kiessling S, Goebel J, Somers M. J.G.Editors. Pediatric Nephrology in the ICU. 2009

3.  Lote C, et al. Mechanism of Acute Renal Failure. Br J Anesth 1996; 77:82-9.

Jaime M. Restrepo, MD. Transplantation and Clinical Research Unit. Fundación Valle Del Líli, Cra. 98 # 18-49, Phone Number: (57) 2 3319090, Ext. 7335 E-mail: