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Advisor(s)
Abstract(s)
RESUMO A insuficiência renal aguda (IRA) é
uma situação rara em idade pediátrica,
podendo surgir aliada a variadas condições
clínicas. Quando as medidas de
suporte não são suficientes para o controlo
da IRA, torna-se necessário o início
de terapêutica de substituição da função
renal.
Objectivo: Analisar as indicações e
complicações dos diferentes métodos de
diálise aguda nos doentes internados na
Unidade de Cuidados Intensivos e/ou no
Serviço de Nefrologia Pediátrica do Hospital
Maria Pia.
Doentes e métodos: Foi efectuado
um estudo retrospectivo dos doentes
com IRA que necessitaram de tratamento
substitutivo da função renal entre Janeiro
de 1990 e Dezembro de 2004. Analisaram-se aspectos clínicos e laboratoriais,
indicações e complicações do procedimento
dialítico e evolução dos doentes.
Foi analisado também, o número anual
de doentes tratados com diálise aguda
no Hospital.
Resultados. O estudo incluiu 29
crianças com idades comprendidas entre
1 e 15 anos, dos quais onze (37,9%)
tinham menos de 12 meses de idade (6
recém nascidos).
A sépsis foi a condição subjacente
à IRA em 11 (37,9%) doentes, sendo predominante
no grupo de recém nascidos.
O síndrome hemolítico urémico foi a etiologia
de IRA em 10 (34,5%) lactentes e
crianças.
A diálise peritoneal foi a modalidade
dialítica mais frequentemente utilizada
(65,5%), seguida da hemodiálise
intermitente (31%) e hemodiafiltração
venovenosa contínua (3,4%). As técnicas
dialíticas mostraram-se seguras e eficazes,
embora com algumas complicações
inerentes ao método dialítico, as quais
foram resolvidas com sucesso. A mortalidade
dos doentes foi de 17,2%, o que é
um resultado bastante satisfatório quando
comparada a outras séries.
A evolução através dos anos do
número de doentes submetidos a diálise
aguda caracterizou-se por um aumento
do número de casos. Nos últimos 5
anos foram tratados 16 dos 29 doentes,
observando-se um investimento recente
destas técnicas em recém-nascidos, incluindo
prematuros de baixo peso.
Conclusões: Verifica-se um aumento
crescente de técnicas diáliticas
nos doentes com IRA, as quais se têm
mostrado eficazes e seguras. Destaca-se
o seu uso em recém nascidos e prematuros
de baixo peso com bons resultados.
A diálise peritoneal permanece a técnica
mais utilizada entre nós, contudo reconhecemos
as vantagens das técnicas
dialíticas extracorporais contínuas o que
tem motivado um investimento recente
neste tipo de tratamento dialítico.
ABSTRACT Acute Renal Failure (ARF) is an uncommon disease in paediatric age, and may occur associated to several clinical conditions. When the support measures are not enough to control ARF, substitution therapeutics become necessary. Objective: To analyse the indications and complications of the different dialysis modalities at the Intensive Care Unit and/ or Paediatrics Nephrology Department in Maria Pia Hospital. Patients and methods: The authors present a retrospective study of ARF patients who needed substitutive treatment of renal function between January 1990 and December 2004. We analysed the following: clinical and laboratorial data, indications and complications of dialysis and patients’ evolution. We was also analysed the evolution of the dialytic treatment in our hospital. Results: The study included 29 children with ARF treated with dialytic therapies, aged 1 day to 15 years. Eleven (37,9%) were 12 months or younger (6 newborns). Sepsis was the subjacent condition to ARF in 11 (37,9%) patients, the majority newborns. The uraemic haemolytic syndrome was the aetiology of ARF in 10 (34,5%) infants and children. The peritoneal dialysis was the most used dialytic modality (65.5%), followed by the intermittent haemodialysis (31%) and continuous venovenous haemodiafiltration (3,4%). The dialytic therapy proved to be safe and efficient, although carrying some inherent complications to the dialytic method, that were resolved with success. Mortality was 17,2%, which is a rather satisfactory result when compared with other series. The number of patients submitted to dialysis in our hospital has been increasing, through the years (16 patients out of 29 were treated after 1999), specially newborns and low birth weight newborns. Conclusion: We verified an increasing use of dialytic techniques in patients with ARF, which are safe and effi cient. We emphasize the good results in newborn including the low birth weight. Peritoneal dialysis remains the most used technique in our hospital, however nowadays, we are investing in the continuous extracorporeal dialysis as we recognize the advantages of this method in critical patients.
ABSTRACT Acute Renal Failure (ARF) is an uncommon disease in paediatric age, and may occur associated to several clinical conditions. When the support measures are not enough to control ARF, substitution therapeutics become necessary. Objective: To analyse the indications and complications of the different dialysis modalities at the Intensive Care Unit and/ or Paediatrics Nephrology Department in Maria Pia Hospital. Patients and methods: The authors present a retrospective study of ARF patients who needed substitutive treatment of renal function between January 1990 and December 2004. We analysed the following: clinical and laboratorial data, indications and complications of dialysis and patients’ evolution. We was also analysed the evolution of the dialytic treatment in our hospital. Results: The study included 29 children with ARF treated with dialytic therapies, aged 1 day to 15 years. Eleven (37,9%) were 12 months or younger (6 newborns). Sepsis was the subjacent condition to ARF in 11 (37,9%) patients, the majority newborns. The uraemic haemolytic syndrome was the aetiology of ARF in 10 (34,5%) infants and children. The peritoneal dialysis was the most used dialytic modality (65.5%), followed by the intermittent haemodialysis (31%) and continuous venovenous haemodiafiltration (3,4%). The dialytic therapy proved to be safe and efficient, although carrying some inherent complications to the dialytic method, that were resolved with success. Mortality was 17,2%, which is a rather satisfactory result when compared with other series. The number of patients submitted to dialysis in our hospital has been increasing, through the years (16 patients out of 29 were treated after 1999), specially newborns and low birth weight newborns. Conclusion: We verified an increasing use of dialytic techniques in patients with ARF, which are safe and effi cient. We emphasize the good results in newborn including the low birth weight. Peritoneal dialysis remains the most used technique in our hospital, however nowadays, we are investing in the continuous extracorporeal dialysis as we recognize the advantages of this method in critical patients.
Description
Keywords
Insuficiência renal aguda diálise criança Acute Renal Failure dialysis children
Citation
Nascer e Crescer 2006; 15(2): 71-76