Presentation on theme: "Pediatric Renal Disease Alyssa Brzenski. Case #1 A 33 year old female G2P1 at 20 weeks presents for evaluation of fetal bladder distention which was found."— Presentation transcript:
Case #1 A 33 year old female G2P1 at 20 weeks presents for evaluation of fetal bladder distention which was found on routine prenatal ultrasound. There were no other abnormalities found. The mother wants to know what is the prognosis and what interventions she should undergo.
Posterior Urethral Valve 1:5,000 births 1:2,500 prenatal ultrasounds Most common obstructive uropathy
Long term Side Effects Renal Scaring Renal Failure Decreased amniotic fluid Pulmonary Hypoplasia
Goals of Treatment Prevent recurrent UTI Prevent Renal Damage/scarring Minimize the morbidity of treatment and followup
Antibiotic Prophylaxis Less than 1 years old Febrile UTI- Antibiotic prophylaxis Afebrile UTI with Grade III-V reflux- Antibiotic Prophylaxis Afebrile UTI with Grade I or II reflux- may offer antibiotic prophylaxis Older than 1 years old Febrile UTI- conservative management or antibiotic prophylaxis Recurrent UTI- start antibiotic treatment or if on antibiotics surgical treatment
Who needs surgery? Children with recurrent infections despite antibiotic prophylaxis Children who have developed renal scaring or poor renal function Severe reflux (Grade V or bilateral IV) Mild to moderate reflux that persists as the patient approaches puberty
Deflux Injections GA for cystoscopy Submucosal Injection of Deflux (dextranomer microspheres and hyaluronic acid) 80-90% success at first injection
Ureteral Re-implant GA Routine Monitors Balanced anesthetic Epidural or Caudal for post-op pain management and to reduce post-op bladder spasm
Case 4 5 year old, 15kg, female with chronic renal failure, secondary to polycystic kidney disease, is admitted for a kidney transplant. She is currently on peritoneal dialysis and was last dialyzed yesterday. She has limited exercize tolerance. Labs including potassium are all normal. ECHO was normal.
Causes of Pediatric Renal Failure From NAPRTCS Annual Report. 2010. Accessed March 25, 2013 at www.naprtcs.orgwww.naprtcs.org
Polycystic Kidney Disease Autosomal Dominant- 90% of cases Typically presents in adulthood with macrocysts Autosomal Recessive- 10% of cases Presents in-utero screening or in early in infancy Microcysts of the collecting tubules
Autosomal Recessive Polycystic Kidney Disease Affects Kidneys- 30% progress to ESRD by 1 st decade with 58% needing a renal transplant by adulthood Liver- 50% will develop hepatic fibrosis with seqelae of portal hypertension May have pulmonary hypoplasia from decreased urine production in-utero
Anesthetic Considerations Intravenous Induction Routine Monitors, CVP +/- Aline Balanced Anesthetic Epidural for Post-op Pain Control
Anesthetic Considerations On release of the renal artery clamp, have CVP of 10-15 with blood pressure at baseline or 10% higher (may need pRBC or dopamine) Adult kidney in a small child or infant will require a significant portion of total blood flow, leading to potential hypotension (volume load prior) Small infants or very sick children should remain intubated, but most children can be extubated in the OR
When should we remove a kidney? Nephrectomy before transplant due to: Large proteinuria Refractory Hypertension Recurrent UTI or urosepsis Urolithiasis Polyuria
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