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Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0-21.2). Median time to first infection was 2.03 months (range 0.1-21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socioeconomic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socioeconomic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success. Keywords Peritonitis * Pediatric * Risk factors Socio-economic circumstances * Outcome, Introduction Frequently occurring diseases in developing countries, such as acquired immunodeficiency syndrome (AIDS), tuberculosis, malaria, gastro-enteritis, and hypertension are often complicated by renal diseases [1]. No reliable statistics are available [...]

Patients with end-stage renal disease require renal replacement therapy with maintenance hemodialysis or chronic peritoneal dialysis while awaiting transplantation. In addition to economic issues and limited state funding for advanced health care, the lack of trained medical personnel contributes to scarce dialysis facilities for children in developing countries. The establishment and operation of a hemodialysis unit with multidisciplinary facilities is both cost- and labor-intensive. Hemodialysis is usually carried out three times a week in a hospital setting and affects the curricular and extracurricular activities of the patient. Chronic ambulatory or cyclic peritoneal dialysis is technically simpler and allows better nutrition and growth, but is expensive for the majority of patients who must pay out of their own pocket. Multiple initiatives to enhance the training of pediatricians and nurses in skills related to initiating and managing patients on maintenance dialysis have resulted in the improved survival of children with end-stage renal disease. Support from state governments and philanthropic institutions have helped in establishing pediatric nephrology units that are equipped to provide renal replacement therapy for children. [ABSTRACT FROM AUTHOR]

Acute peritoneal dialysis (PD) is the preferred therapy for renal replacement in children with post-diarrheal hemolytic uremic syndrome (D+ HUS), but peritonitis remains a frequent complication of this procedure. We reviewed data from 149 patients with D+ HUS who had undergone acute PD with the aim of determining the prevalence and risk factors for the development of peritonitis. A total of 36 patients (24.2%) presented peritonitis. The median onset of peritonitis manifestations was 6 (range 2-18) days after the initiation of dialysis treatment, and Gram-positive microorganisms were the predominant bacterial type isolated (15/36 patients). The patients were divided into two groups: with or without peritonitis, respectively. Univariate analysis revealed that a longer duration of the oligoanuric period, more days of dialysis, catheter replacement, stay in the intensive care unit, and hypoalbuminemia were significantly associated to the development of peritonitis. The multivariate analysis, controlled by duration of PD, identified the following independent risk factors for peritonitis: catheter replacement [ p = 0.037, odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02-1.73], stay in intensive care unit ( p = 0.0001, OR 2.62, 95% CI 1.65-4.19), and hypoalbuminemia ( p = 0.0076, OR 1.45, 95% CI 1.10-1.91). Based on these findings, we conclude that the optimization of the aseptic technique during catheter manipulation and early nutritional support are targets for the prevention of peritonitis, especially in critically ill patients. [ABSTRACT FROM AUTHOR]

The article presents abstracts from the 15th Congress of the international Pediatric Nephrology Association. The medical topics of the abstracts include Epstein-Barr virus (EBV) in children who underwent renal transplantation, early proteinuria after renal transplantation and steroid resistant nephrotic syndrome.

We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted between July 1994 and Febmary 1996, following an outbreak of Shigella dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excluding 1, were black with a mean age of 38 months (range 1-121); 50 (61.7%) were males. The mean duration of dysentery was 11.3 days (range 1-41) and HUS 15 days (range 1-91). Most patients had acute oliguric renal failure (90.1%); 42 (51.6%) required peritoneal dialysis. Complications included encephalopathy 30 (37.0%), convulsions 12 (14.8%) and hemiplegia 2 (2.3%), gastrointestinal perforation 8 (9.9%), protein losing enteropathy 26 (32.1%), toxic megacolon 4 (4.9%), rectal prolapse 5 (6.2%), hepatitis 11 (13.6%), myocarditis 5 (6.2%), congestive cardiac failure 3 (3.7%), cardiomyopathy 3 (3.7%), infective endocarditis 1 (1.2%), septicemia 15 (18.5%), disseminated intravascular coagulation 17 (21%). Leukemoid reactions were found in 74 (91.3%) patients, hyponatremia in 56 (69.1%), and hypoalbuminemia in 67 (82.7%). Stool culture for Shigella dysenteriae type I was positive in only 7 (8.6%) patients; Shiga toxin assays were not performed. Outcome was as follows: recovery 32 (39.5%), impaired renal function 8 (9.9%), chronic renal failure 26 (32.1%), end-stage renal disease 1 (1.2%), and death 14 (17.3%) patients. [ABSTRACT FROM AUTHOR]

Black South African children have an increased prevalence of acute post-streptococcal glomerulonephritis, focal glomerulosclerosis, hepatitis B-associated membranous nephropathy, congenital syphilis, congenital nephrotic syndrome with Alport-like basement membrane changes and Takayasu's arteritis, but a paucity of reflux nephropathy, polycystic kidney disease and non-shigella-induced haemolytic uraemic syndrome. However, in recent years, the haemolytic uraemic syndrome has become more prevalent in black children; this is usually due to Shigella dysenteriae type 1, and could indicate a different emphasis in the pathogenic mechanism. Focal glomerulosclerosis is the commonest reason for renal failure requiring transplantation in black children with rapidly progressive glomerulonephritis (usually streptococcal induced) being second. Transplantation has been somewhat problematic with a scarcity of kidneys at times, many mismatches and poor compliance in the lower socio-economic groups. The association of tuberculosis with focal glomerulosclerosis and Takayasu's arteritis in black South African children is intriguing. The progression of focal glomerulosclerosis is accelerated in those patients with evidence of previous tuberculosis, and in Takayasu's arteritis the association is almost absolute as experienced locally, with the data suggesting an autoimmune reaction. [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) with elevated serum uric acid (UA) levels has been reported in patients with hemolytic uremic syndrome (HUS). AKI is thought to result from tubular obstruction [...]