The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency. Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery.
The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1 g/kg/day) or the control group. All children were followed up by the same paediatrician and dietitian. After a follow up period of three years there was no significant difference in glomerular filtration rate between children on a protein restricted diet and children of the control group. There was no significant difference in weight with respect to height and height SD score between the protein restricted and the control group. Compliance with the protein restricted diet, as indicated by the prospective diet diaries and the serum urea:creatinine ratio, was good. This study shows that children with chronic renal failure do not benefit from a protein restricted diet.
We studied amino acid concentrations in granulocytes and plasma of 24 children with chronic renal failure and 15 healthy children. Granulocytes were isolated from 10 ml of blood using a dextran-Ficoll-Hypaque procedure. Intracellular levels of leucine, isoleucine, methionine, phenylalanine, lysine, histidine, tyrosine, and arginine were significantly lower in children with chronic renal failure than healthy children. There were no significant differences in intracellular and plasma amino acid concentrations between children with chronic renal failure on a well-balanced protein-restricted diet and children with chronic renal failure with a normal protein intake.
Summary In a retrospective study renal function and renal replacement therapy after cardiopulmonary bypass surgery in children was investigated at the Department of Cardiothoracic Surgery at the Leiden University Medical Center and Academic Medical Center of Amsterdam. Patient characteristics (sex, age, diagnosis), operation type and death were listed. Serum creatinine level before and peak values after cardiopulmonary bypass surgery were used for assessment of renal function. For the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period (1994)(1995)(1996)(1997)(1998)(1999), 1075 children had cardiopulmonary bypass surgery. Of the patients 180 (17%) developed acute renal insufficiency. Twenty-five (2,3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children post cardiopulmonary bypass surgery. However, 15 (60%) of the 25 children on renal replacement therapy died of non-renal causes. In 9 of the 10 surviving children renal function was normal at the time of discharge. In conclusion, acute renal insufficiency is a frequent complication after openheart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiopulmonary bypass surgery.Samenvatting In een retrospectieve studie werden het vo´o´rkomen van acute nierinsufficie¨ntie en nierfunctievervangende therapie bij kinderen na cardiopulmonale bypasschirurgie onderzocht in het Centrum voor Aangeboren Hartafwijkingen Amsterdam/Leiden. Klinische gegevens van de patie¨nten (geslacht, leeftijd, diagnose), type cardiochirurgische interventie en mortaliteit werden vastgelegd. De nierfunctie werd gee¨valueerd aan de hand van de serumcreatinineconcentratie preoperatief en de maximale serumcreatinineconcentratie postoperatief. Van de kinderen die nierfunctievervangende therapie ondergingen, werden indicatie, efficie¨ntie en complicaties bestudeerd. In een vijfjaarsperiode (1994)(1995)(1996)(1997)(1998)(1999) ondergingen 1075 kinderen cardiopulmonale bypasschirurgie. Van de kinderen ontwikkelden 180 (17%) een acute nierinsufficie¨ntie. Vijfentwintig (2,3%) kinderen hadden nierfunctievervangende therapie nodig. Van de 25 kinderen met nierfunctievervangende therapie zijn 15 (60%) kinderen overleden aan niet-renale oorzaken. Negen van de tien overlevende kinderen met nierfunctievervangende therapie hadden een normale nierfunctie bij ontslag. Concluderend:acute nierinsufficie¨ntie is een frequente complicatie na cardiopulmonale bypasschirurgie, maar nierfunctievervangende therapie is zelden nodig. Peritoneale dialyse is een veilige en effectieve behandeling bij kinderen na cardiopulmonale bypasschirurgie.
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