Hemodialysis in Infantile Nephrotic Syndrome

Abstract

The application of hemodialysis for the treatment of renal failure in the older child is fairly extensive 1-6 and has been recently reviewed by Clapp et al.7 The literature contains reports of infants aged 4 months, 11\ m=1/ 2\ months,9 and 7 months10 who have been treated successfully by hemodialysis. To date only peritoneal dialysis to remove bilirubin 8 has been reported in infants under three months of age. The development of a control system for the oxygenation of infants by extracorporeal perfusion 11 has been modified for the hemodialysis of such small infants. This report briefly describes the successful hemodialysis of a six-week-old infant with congenital nephrosis together with data from preparatory animal experiments. Report of CaseA six-week-old female infant was admitted with a three-week history of swelling around the eyes and pitting edema in the legs.After a third-trimester toxemia the infant, weighing 3,100 gm (6\m=7/8\lb) was born at term by forceps delivery. Vomiting and irritability, pre¬ viously mild, became severe in the week preceding admission. Wheezing and cough were noted, and the edema became generalized over the face, ab¬ domen, hands and legs. Prior to admission, uri¬ nalysis revealed proteinuria, pyuria, and bacturia.Protein electrophoresis indicated hypoalbuminemia and relative hyperglobulinemia. The hemoglobin was 9.2 gm/100 ml, the ESR 19 mm/hr, the BUN 12.5 mg/100 ml, and the serum cholesterol 202 mg/ 100 ml. Abdominal paracentesis had yielded 100 ml of fluid.On admission the temperature was 37 C, pulse 120/min, respirations 50/min. She was found to be a pale, irritable dyspneic infant weighing 3,400 gm (7Vi lb). There was marked generalized edema and seepage of fluid from the paracentesis site. Inspiratory ronchi and crépitant rales were heard posteriorly over the left chest. Ascites but no visceromegaly was noted in the abdomen. Systematic review was otherwise negative.Laboratory Investigations and Course.-The hematocrit was 24% and the WBC 18,350/cu mm with 74% neutrophils. Target cells and normoblasts were seen, and the reticulocyte count was 0.8%. Urinalysis revealed 4+ proteinuria, less than three red and ten white cells per high-power field, but up to 10,000 colonies of Escherichia coli and 10,000 of paracolon bacteria were cultured. The 24-hour urine output dropped from 110 ml to 5 ml in the first four days of admission. The first blood culture grew paracolon bacteria, but repeat cultures after antibiotics were negative. Serial serum chemistries are shown in Table 1. In addition, the serum cholesterol was 275 mg/100 ml, and the blood glu¬ cose was 85 mg/100 ml. The urine osmolality on