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Ready for a #NeoNeph #tweetorial? Let's look at kidney support therapy (KST) in #neonates.
@ASPNeph @EBNEO @MedTweetorials @MedEdBot @IrishNeonatal @AAPneonatal #SoMe
Credit: NICKS course by @DDD_Askenazi & team. Great article by @menonshina https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777586/
Ready for a #NeoNeph #tweetorial? Let's look at kidney support therapy (KST) in #neonates.
@ASPNeph @EBNEO @MedTweetorials @MedEdBot @IrishNeonatal @AAPneonatal #SoMe
Credit: NICKS course by @DDD_Askenazi & team. Great article by @menonshina https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777586/
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First, what are the indications for KST?
The classic AEIOU + to allow optimization of nutrition which is critical in the neonatal population.
First, what are the indications for KST?
The classic AEIOU + to allow optimization of nutrition which is critical in the neonatal population.
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Before initiation of KST, a multidisciplinary discussion between neo and neph needs to happen and include the family when assessing candidacy for KST. Often, pulmonary status is a major determinant of the yield of KST in neonates esp in babies with pulmonary hypoplasia.
Before initiation of KST, a multidisciplinary discussion between neo and neph needs to happen and include the family when assessing candidacy for KST. Often, pulmonary status is a major determinant of the yield of KST in neonates esp in babies with pulmonary hypoplasia.
4/ What are the necessary steps before initiation of KST?
A. Ensure adequate MAP/GA for perfusion
B. Replace nephrotoxic medications
C. Evaluate infant for abdominal compartment syndrome, why? could affect kidney perfusion
D. Diuretic +/- albumin trial, not for too long though.
A. Ensure adequate MAP/GA for perfusion
B. Replace nephrotoxic medications
C. Evaluate infant for abdominal compartment syndrome, why? could affect kidney perfusion
D. Diuretic +/- albumin trial, not for too long though.
5/ What are the principals of KST?
A. Clearance (diffusive, osmotic or convective)
B. Fluid removal (osmotic or convective)
Life examples: tea bag in a cup of water (diffusion), coffee machine, waterfalls (convection).
For all modalities, you need blood flowing and a filter.
A. Clearance (diffusive, osmotic or convective)
B. Fluid removal (osmotic or convective)
Life examples: tea bag in a cup of water (diffusion), coffee machine, waterfalls (convection).
For all modalities, you need blood flowing and a filter.
6/ Options for KST for neonates and infants < 1.5-2 Kg are sometimes limited.
For babies without significant abdominal malformations, PD is a good choice.
A. Acute PD catheters could be some nephrologists at the bedside to provide manual PD. Main risk is leakage.
For babies without significant abdominal malformations, PD is a good choice.
A. Acute PD catheters could be some nephrologists at the bedside to provide manual PD. Main risk is leakage.
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B. Surgical PD catheter: better than A, however patient weight & abdominal conditions (wall defects, CDH) could be barriers. Leakage, esp if used immediately is a painful limitation
Mechanisms of PD include diffusion/osmosis (your tea cup example), negligible convection.
B. Surgical PD catheter: better than A, however patient weight & abdominal conditions (wall defects, CDH) could be barriers. Leakage, esp if used immediately is a painful limitation
Mechanisms of PD include diffusion/osmosis (your tea cup example), negligible convection.
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Hemodialysis & CRRT are challenging in neonates in the absence of small-volume extracorporeal circuits. Advanced-neonatal care centers use devices as aquadex & carpediem which have smaller volumes. See below for comparison of available machines.
Hemodialysis & CRRT are challenging in neonates in the absence of small-volume extracorporeal circuits. Advanced-neonatal care centers use devices as aquadex & carpediem which have smaller volumes. See below for comparison of available machines.
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Some of the above devices are available in the US
Can you think of one condition when it is life-saving to perform urgent HD in a neonate to achieve rapid clearance?
In that condition, there're case reports of using high-dose CRRT as well. Let me know your answer
Some of the above devices are available in the US
Can you think of one condition when it is life-saving to perform urgent HD in a neonate to achieve rapid clearance?
In that condition, there're case reports of using high-dose CRRT as well. Let me know your answer
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The prismaflex (volume of 100-165 ml) could easily be used in babies on ECMO since the extracorporeal volume and anticoagulation are already taken care of
. When using the prismaflex you will have the options to run CVVH, CVVHD or CVVHDF.
The prismaflex (volume of 100-165 ml) could easily be used in babies on ECMO since the extracorporeal volume and anticoagulation are already taken care of
. When using the prismaflex you will have the options to run CVVH, CVVHD or CVVHDF.
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Aquapheresis (ultrafiltration/SCUF) & modified aquapheresis (CVVH) been used in adults with CHF, and several pediatric centers are currently using it as a modality for KST in neonates. At @NCHforDocs, these modalities will soon be available as options for neonatal KST.
Aquapheresis (ultrafiltration/SCUF) & modified aquapheresis (CVVH) been used in adults with CHF, and several pediatric centers are currently using it as a modality for KST in neonates. At @NCHforDocs, these modalities will soon be available as options for neonatal KST.
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We will discuss aquapheresis & our experience (with our aqua lead @BethAVogtMD1) in a separate #tweetorial.
I hope you enjoyed this brief summary. Let me know if there's a particular part that you wish to learn more about
Thank you for reading.
We will discuss aquapheresis & our experience (with our aqua lead @BethAVogtMD1) in a separate #tweetorial.
I hope you enjoyed this brief summary. Let me know if there's a particular part that you wish to learn more about
Thank you for reading.
