6 Causes of ESRD in neonates PrerenalIntrinsicPostrenal
7 Causes of intrinsic renal ESRD in neonates PrenatalAgenesisHypoplasiaDysplasiaCystic diseasesObstructionPostnatalDIC, ATN
8 What is the general consensus for intrinsic ESRD in neonates?
9 Intrinsic renal ESRD in neonates RareExtremely poor prognosisRenal replacement therapy not always recommended. As recently as 1998, only 40% of international pediatric nephrologists would offer dialysis to infants < 1 month(J. Pediatr 1998, 133, )
11 Survival after dialysis in neonates with ESRD Age atstartnSurvival%Matthews et al,J Ped Surg1990<2 m3139infants whose renal failure was isolated were more likely to undergo successful dialysisBlowey et al,JPerinatol. 1993<1 y2365Ellis et al, AdvPerit Dial. 19952180-36infants with anuria or oliguria had a higher mortality (64%) than did infants with adequate urine output (20%).Warady et al,Pediatr Nephrol 99<3 m3476Coulthard et al, Arch Dis Child 2002<1 m55Williams et al, ArchPediatr AdolescMed 20021 d-1 y3553Laakkonen et alNephrol Dial Transplant 20081d-2 m990
12 Outcomes of dialysis initiated during the neonathal period for treatment of ESRD: a NAPRTCS special analysis.Pediatrics 2007: ; 119
13 For physicians and parents alike, the decision to initiate long-term dialysis for a neonate with presumptive ESRD poses a complex ethical quandary.This dilemma derives,at least in part, from the paucity of published reports describing the outcomes of infants who initiate dialysis during the first month of life.Neonates were as likely to terminate dialysis during the study period as were older children. However, the reason for terminating dialysis differed significantly between the 2 age groups. Neonates were more likely to terminate because of death, and they were less likely to terminate because of transplantation.
14 Death 17/193 Recovery of function 23/193 Neonates with renal dysplasia or obstructive uropathy are at risk for associated congenital anomalies, either true malformations or deformations, because of severe oligohydramnios. In such cases, the presence of significant comorbid conditions may preclude long-term dialysis as a bridge to renal transplantation, thus excluding these neonates from the NAPRTCS database.
15 Aetiology and outcome of acute and chronic renal failure in infants Nephrol Dial Transplant (2008) 23: 1575–1580Between 1997 and 2004 all children <1 year of age witha serum creatinine >100 µmol/l were followed up for up to 6 years.- 49 infants with ESRD- 21 started dialysis between days of age4 neonates were not offered RRT because of parents wishmortality: ARPKD 100%dysplasia 22%obstraction 6%
16 n TOP % Survival % ARPKD 20 45 30 ADPKD 7 28 71 Others 9 67 33 Prenatal diagnosis of bilateral isolated fetal hyperechogenickidneys. Is it possible to predict long term outcome?Brit J Obs Gyn 2002nTOP %Survival %ARPKD204530ADPKD72871Others96733
17 Congenital renal tract anomalies: outcome and follow-up of 402 cases detected antenatally between 1986 and 2001Ultrasound Obstet Gynecol 2005nTOP %Survival %Bilateral agenesis, MCDK, PDCK, dysplasia76483Unilateral agenesis,MCDK, dysplasia74683
19 Renal failure, comorbidity and mortality in preterm infants Wien Klin Wochenschr (2008) 120/5–6: 153–15716 RF/ 359 <37 GA (4,5%)nSurvival %Pre/post1433Cong. anomalies2
20 Antenatal oligohydramnios of renal origin: long-term outcome Nephrol Dial Transplant (2007) 22: 432–439A total of 23 infants (16 males, 7 females) with an antenataldiagnosis of oligohydramnios were retrospectively studied- Survival 70%4 children were not offered RRT (GA 34-39)only 2 children started dialysis at birth (GA 38-40)