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1.
Pediatr Nephrol ; 35(1): 119-126, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31673828

RESUMO

BACKGROUND: This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy. METHODS: Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites. RESULTS: Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis. CONCLUSION: Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.


Assuntos
Colostomia/efeitos adversos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Anormalidades Urogenitais/terapia , Refluxo Vesicoureteral/terapia , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Criança , Pré-Escolar , Colostomia/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Falência Renal Crônica/etiologia , Falência Renal Crônica/mortalidade , Masculino , Diálise Peritoneal/estatística & dados numéricos , Peritonite/tratamento farmacológico , Peritonite/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/mortalidade , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/mortalidade
2.
Pediatr Nephrol ; 33(1): 41-51, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28444445

RESUMO

Acquired cystic kidney disease (ACKD) is a condition that occurs predominantly in patients with end-stage renal disease (ESRD). In contrast to hereditary cystic kidney disease, ACKD is characterized by the presence of multiple small cysts in bilaterally small kidneys. Limited pediatric data suggest a high incidence (21.6-45.8%) of ACKD in children on dialysis, comparable to that in adults, with an increased frequency associated with a longer duration of dialysis. Recent research has shed light on the pathogenesis of ACKD, such as activation of proto-oncogenes. Although most patients with ACKD are asymptomatic, the condition can be complicated by renal cell carcinoma. Routine surveillance should therefore be considered in at-risk populations.


Assuntos
Carcinoma de Células Renais/etiologia , Doenças Renais Císticas/complicações , Falência Renal Crônica/complicações , Neoplasias Renais/etiologia , Rim/patologia , Adolescente , Feminino , Humanos , Incidência , Doenças Renais Císticas/diagnóstico , Masculino , Diálise Renal/efeitos adversos , Fatores de Risco
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