This case series shows that chronic HD is a viable management option in children <10 kg. Access issues can be minimized with good line care to maximize line longevity and minimize line infection rates.
Children on hemodialysis are at increased risk of thrombosis, especially when dialyzed via a central venous catheter (CVC); there are limited published data regarding the safety and efficacy of tinzaparin in this group. We conducted a retrospective chart review of all children in the National Pediatric Hemodialysis Centre for Ireland diagnosed with a CVC thrombus and treated with subcutaneous tinzaparin over a 10 year period. Seven children were treated with subcutaneous tinzaparin for 10 CVC thrombi. Tinzaparin was commenced at 175 IU/kg/day and the dose was titrated by measuring anti-factor Xa levels, aiming for levels of 0.3-1.0 IU/ml. Treatment was continued until resolution of the CVC thrombus. Restoration of normal flows during dialysis occurred within 3 days in all patients. There were no episodes of bleeding and all children tolerated the treatment well.
Background: CAKUT are the most common cause of end-stage renal failure in children (Pediatr Nephrol. 24, 2009, 1719. Many children with CAKUT have poor urinary drainage which can compromise post-transplant outcome. Identifying safe ways to manage anatomical abnormalities and provide effective urinary drainage is key to transplant success. Much debate exists regarding optimum urinary diversion techniques. The definitive formation of a continent urinary diversion is always preferable but may not always be possible. We explore the role of ureterostomy formation at transplantation in a complex pediatric group. Methods:We report six pediatric patients who had ureterostomy formation at the time of transplantation at the National Paediatric Transplant Centre in Dublin, Ireland. We compared renal function and burden of urinary tract infection to a group with alternative urinary diversion procedures and a group with normal bladders over a 5-year period.Results: There was no demonstrable difference in estimated glomerular filtration rate between the groups at 5-year follow-up. The overall burden of UTI was low and similar in frequency between the three groups.Conclusions: Ureterostomy formation is a safe and effective option for temporary urinary diversion in children with complex abdominal anatomy facilitating transplantation; it is, however, important to consider the implications and risk of ureterostomy for definitive surgery after transplantation. K E Y W O R D S congenital anomalies of kidney and urinary tract, pediatric renal transplantation, ureterostomy, urinary diversion 1 | INTRODUC TI ON CAKUT include a variety of structural abnormalities which together account for the majority of end-stage renal disease, and a large proportion of renal transplantation in children. 1 Many children with CAKUT have significant bladder dysfunction, with poor drainage capability. 2,3 Historically children with CAKUT were often precluded from transplantation due to concerns regarding the impact of a dysfunctional How to cite this article: Costigan CS, Raftery T, Riordan M, et al. Long term outcome of transplant ureterostomy in children:
Background: Haemodialysis catheter (HDC) occlusion is a common cause of poor blood flow, inadequate dialysis and HDC loss. From Jan 2009, our unit used infusions of recombinant tissue plasminogen activator (rtPA), Alteplase 0.1-0.2 mg/kg/hour over 1-2 hours for thrombolysis of occluded catheters. Methods: Retrospective review of outcomes of all patients who were treated with rtPA infusion for HDC occlusion in our unit between Jan 2009 to Dec 2012. Twenty patients underwent 5,407 sessions of catheter-directed haemodialysis in our unit (mean age 7.4 years, range 0.3-15.8 years). Results: Ten patients accounted for 339 episodes of rtPA infusions (median 12, range 1-115). Thirty-three radiographic contrast studies were performed-21 (64%) confirmed presence of thrombus. The immediate success rate, defined as return of manual aspiration and infusion capabilities to both ports was 100%. No patients required exclusion from thrombolytic therapy due to contraindications. One patient had rtPA infusion discontinued after 9 infusions due to spontaneous bruising despite normal fibrinogen levels. The remainder of patients tolerated the treatment well. All patients had normal coagulation profile. No HDC were surgically changed due to occlusion by thrombus. Conclusion: Low dose Alteplase infusion is safe and efficacious in the management of HDC occlusion. It provides a means for improving the long-term survival of HDC catheters in patients with limited available options of vascular access for haemodialysis.
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