it's hard to put somebody on chronic dialysis if there's not some prospect of transplantation down the road, because if, if for some reason transplantation doesn't sound like it will become an option, then one sort of enters a never ending one-way street that can become quite quite challenging
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
▶Ep 1 · 10:06
quotewe really like urine and we're talking about babies who have urine↗
▶Ep 1 · 10:32
quoteany kind of urine is much better than no urine↗
▶Ep 1 · 10:32
clinicalAny kind of urine is much better than no urine, even if it's bad urine that is just water and doesn't contain much cleared metabolites↗
▶Ep 1 · 11:03
clinicalBabies with obstructive neuropathy oftentimes have a concentrating defect and they make lots of urine↗
▶Ep 1 · 11:09
quoteIt may again be bad urine, but at least it's fluid↗
▶Ep 1 · 13:24
guidelineAt Cincinnati, the size for safe kidney transplantation is typically somewhere between 8 and 10 kg, putting the timeline probably somewhere into the second year of life↗
▶Ep 1 · 14:21
clinicalBladder pressure is important not only prenatally but also postnatally↗
▶Ep 1 · 14:52
clinicalObstructive neuropathy bladders can be very high pressure and can also change over time, so they need to be followed regularly and management may change↗
▶Ep 1 · 15:40
clinicalWe don't really see that much hypertension in these babies because they have such high urine output, so they don't tend to be volume overloaded↗
▶Ep 1 · 15:56
clinicalThese babies tend to lose sodium because their tubules aren't working, so it's harder for them to retain sodium as another mechanism for hypertension↗
▶Ep 1 · 19:31
clinicalNormal babies with normal urinary tracts and normal kidneys spend their first year of life developing normal kidney function, with normal GFR for a newborn at 1 month of age being about 50, taking a whole year to reach the normal GFR of about 100↗
▶Ep 1 · 20:14
clinicalWe can't make reasonable predictions based on clearance and creatinine until somebody has spent that first year of life establishing what their kidney function is going to be↗
▶Ep 1 · 20:42
guidelineGFR criteria for chronic kidney disease staging don't apply to children less than 2 years of age - we can only categorize them into normal, moderately reduced, or very severely reduced age-adjusted GFR↗
▶Ep 1 · 21:42
opinionDialysis for small children remains quite challenging but has been improved as far as outcomes and feasibility and should be discussed with families on an individualized basis↗
▶Ep 1 · 22:45
clinicalFailed CKD management requiring dialysis is indicated when the baby stops growing (length, weight, or head circumference) or when we can't medically manage hyperkalemia or metabolic acidosis↗
▶Ep 1 · 22:51
clinicalThe creatinine itself doesn't really bother us alone - it's how the baby is doing↗
▶Ep 1 · 22:51
quoteThe creatinine itself doesn't really bother us alone. It's how the baby is doing↗
▶Ep 1 · 23:27
clinicalPeritoneal dialysis is the technically least difficult way to provide dialysis in small children↗
▶Ep 1 · 24:53
quotetypically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job↗
▶Ep 1 · 24:53
epidemiologicalTypically parents will tell us that if they both held jobs prior to having a complicated baby like this, when that started, one of them usually stopped working and the baby became his or her job↗
▶Ep 1 · 25:17
clinicalUrine output remains a big plus because it's very hard to manage fluid balance with just dialysis if there's not some residual diuresis↗
▶Ep 1 · 25:31
quoteit's hard to put somebody on chronic dialysis if there's not some prospect of transplantation down the road, because if, if for some reason transplantation doesn't sound like it will become an option, then one sort of enters a never ending one-way street that can become quite quite challenging↗
▶Ep 1 · 25:31
opinionIt's hard to put somebody on chronic dialysis if there's not some prospect of transplantation down the road↗
▶Ep 1 · 30:04
clinicalShort term, you can try hemodialytic strategies when PD is not available, but that's typically very challenging because you have to blood prime circuits and put very large catheters into relatively very small blood vessels↗
▶Ep 1 · 30:22
clinicalAquapheresis (ultrafiltration with convective clearance) requires slightly smaller catheters and has been used successfully to maintain an aneuric baby with intraperitoneal problems↗
▶Ep 1 · 30:43
opinionNot being able to do PD in a small child is a very ominous situation↗
▶Ep 1 · 30:43
quotenot being able to do PD in a small child is a very ominous situation↗
▶Ep 1 · 32:34
clinicalNutrition in somebody with urine output is a little easier than in somebody who's oliguric or aneuric because you don't have to concentrate it that much↗
▶Ep 1 · 32:49
clinicalHigh output babies lose all sorts of electrolytes and we find ourselves supplementing some of these electrolytes like phosphorus that we in older patients preach to avoid↗
▶Ep 1 · 33:12
clinicalThe density of the formula is essentially an inverse function of the amount of urine output↗
▶Ep 1 · 33:23
clinicalThe inability to provide adequate protein intake may require dialysis in some babies because you can't manage their BUN otherwise↗
▶Ep 1 · 33:50
clinicalIt's relatively unusual to expect these babies to drink spontaneously in amounts that will supply adequate nutrition↗
▶Ep 1 · 34:15
clinicalMothers' breast milk can be incorporated into specialized formulas that meet the baby's specific needs↗
▶Ep 1 · 34:41
clinicalThe majority of these kids have an NG tube or a gastrostomy tube and keep that even around transplant because they need to be on a bunch of medicines↗
