Background

Conventional dialysis procedures can not remove albumin-binding substances from the blood, such as some drugs, exogenous toxins, and endogenous toxins produced in congenital and acquired metabolic and liver diseases. In those situations, an "albumin dialysis" is used. "Single pass albumin dialysis" - SPAD can be administered by standard apparatus for the continuous renal replacement therapy (CRRT) with the addition of albumin to dialysis solution.

Objectives

We present a seven-years experience in the use of SPAD with different indications in thirteen pediatric patients in the intensive care unit, describe the procedure, clinical course and the outcome.

Methods

SPAD was administered by the device for CRRT, Prismaflex, by adding 1 liter of 20% human albumin to a dialysis solution of 4 l, with a flow rate of 500 to 1000 ml / h. This procedure was used once or twice per day for one or more days, depending on the type of intoxication and the clinical and laboratory response to the applied therapy.

Results

Thirteen patients were treated. Nine of them had acute hepatic insufficiency (Wilson's disease, fungal infusion, DRESS syndrome, liver failure of unknown aetiology). Three children were intoxicated with albumin-binding medicines (carbamazepine, durofiline, digoxin). In one, SPAD was performed due to severe hemolysis. Eight patients survived. Mortality in patients with acute hepatic insufficiency was the highest (44%). All patients treated for drug intoxication survived.

Conclusion

SPAD is an effective method of treatment of intoxication with substances that bind to albumin or for bridging the time to recovery of the function or liver transplantation.

Background

Neonates with renal oligohydramnion (ROH) who require a complex intensive-care management including extensive ventilation strategies due to lung-hypolasia and hemodynamic support are therefore in need of a stable CRRT procedure. Anticoagulation for CRRT in neonates is of high importance to provide stable blood flow and long filter running time.

Objectives

Aim of the analysis is a proof of concept of triple anticoagulation in neonatal VV-CRRT.

Methods

Retrospective data analysis including 5 neonates with ROH. VV-CRRT was performed with Prismaflex® (HF 20 Filter Set, blood priming) via a jugular central venous line ( 5.5-6French), started on day 0-4. Anticoagulation was managed with low-dose Citrate (2.5-3mmol/l), Epoprostenol (5-10ng/kg/min) and Heparin (5-10 IE/kg/h). Bedside ACT was used to titrate Heparin. Adverse events were noted.

Results

5 Neonates, median 37+/-2 weeks of gestation and 3014g (+/-736g) birth weight. Primary disease of ROH were ARPKD (n=1), bilateral renal dysplasia (n=1), BOR syndrome (n=1), posterior urethral valve (n=2). Within median 16d of VV-CRRT (dialysis hours median 300.4+/-57.7) 7 filters with a median filter running time of 46h (range 10-109) were needed. Mean blood flow 13.8ml/h (range 10-16), dialysis dose 97ml/kg/h (+/-55.8; range 48.4-198), UFR 7.27ml/kg/h (+/-1.78; range 5.1-9.7), CaT/CaJ 1.34 (+/-0.3). No bleeding events occurred, ACT goals 160-180 achieved.

Conclusion

Triple anticoagulation as mentioned above with strict ranges is feasible in neonatal VV-CRRT without adverse events (e.g. bleeding) and enables a stable filter running time with less unplanned shutdown as well as a stable low blood flow in a dialysis-equipment primarily built up for adults and adolescents.

Background

Contrast administration is the risk factors for acute kidney injury (AKI) and CI-AKI in critically ill children is not studied well.

Objectives

To study the incidence, risk factor, role of plasma NGAL in CI-AKI and 30-day unfavorable outcome (death, readmission).

Methods

Prospective cohort study of 100 children aged 1-month to 12-year who underwent contrast computed tomography were included. Patient without renal function test, chronic kidney disease, admitted for < 48-hour and serum bilirubin >5 mg/dL were excluded. Serum creatinine measured before and 6, 24, 48-hour after contrast. Plasma neutrophil gelatinase-associated lipocalin (NGAL) was measured before and 6-hour after contrast.

Results

The most common indication for contrast imaging are the brain (59%) and respiratory pathology (18%). Incidence of CI-AKI was 35% (95% CI 26.4% to 44.8%) and 71% in ‘risk’ and 29% in ‘injury’ stage. In multivariate logistic regression, age less than 2-year was independently associated with CI-AKI. There was no significant difference of NGAL before (ROC-AUC 0.38,95%CI 0.26 - 0.50) and 6-hour after contrast study (AUC 0.41, 95%CI 0.29 - 0.54) to predict CI-AKI. There were 8% deaths and no readmission at 30-day. Nineteen out of the 35 (54.2%) of CI-AKI patients had complete renal recovery, while none of them had operational renal recovery (within 10% baseline creatinine level) and none received renal replacement therapy.

Conclusion

Incidence of contrast-induced acute kidney injury was 35% with age less than two years independently associated with CI-AKI. NGAL did not predict the early onset of CI-AKI.

Background

Acute kidney injury (AKI) is a very common and potentially devastating problem in critically ill children with increased morbidity and mortality. Early diagnosis of AKI is often problematic due to the lack of suitable early biomarkers. Serum NGAL as an early marker may overcomes such limitations

Objectives

The aim of this study was to study the role of serum NGAL and other markers of tubular dysfunction as urinary beta 2 microglobulin, albumin/creatinine ratio, and fractional excretion of sodium as early predictors of AKI in cases admitted to Alexandria University PICU.

Methods

This prospective study was conducted on 40 patients admitted to Alexandria University PICU and were evaluated for the presence of AKI with exclusion of patients admitted for less than 48 hours and patients with chronic renal disease.

Serum creatinine and creatinine clearence were done daily in all patients. Serum NGAL, beta 2 microglobulin in urine, albumin / creatinine ratio (Alb/Cr), and fractional excretion of sodium (FENa) were done on admission and on the third day of admission.

The patients were divided into AKI group and non-AKI groups according to pediatric RIFLE score

Results

There was statistical significant difference between the AKI and non-AKI groups regarding level of NGAL in day 1 and day 3

Statistical significant difference and correlation were found between different grades of PRIFLE score regarding level of NGAL, b2-microglobulin, and FENA.

Serum NGAL had a 100% senstivety and 83% specificity to predict AKI in critically ill children.

Conclusion

Serum NGAL is a senstive and specific biomarker to predict AKI in critically ill children.