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Renal Replacement Therapy (PICU)

Renal Replacement Therapy (PICU)

Renal Replacement Therapy (RRT) in the Paediatric Intensive Care Unit (PICU) focuses on providing support to kidney functionality for patients diagnosed with acute kidney injury (AKI) or chronic kidney injury (CKI). The primary functions of the kidney involve filtering waste products and excess fluid from the blood, regulating electrolyte balance, and producing hormones such as vitamin D, erythropoietin, and renin. An impairment of these functions leads to a buildup of toxins and fluid in the body, causing kidney failure, which can be life-threatening.

Manipal Hospitals in Bhubaneswar, Odisha, offer comprehensive care and management to paediatric patients with renal failure. RRT is the preferred method of treatment for paediatric patients suffering from acute kidney injury, congenital metabolic disorders, and critically ill paediatric patients. With cutting-edge technology, we ensure personalised support and attention for every paediatric patient.

FAQ's

Children may experience minimal or no symptoms during the initial phases of kidney disease. Children may display varying symptoms depending on whether they have acute or chronic kidney disease. Symptoms of acute kidney disease (AKD) include:

  • bleeding
  • fever
  • rash
  • bloody diarrhoea
  • severe vomiting
  • abdominal pain
  • absence or excessive urination
  • pale skin, tissue swelling
  • eye inflammation
  • abdominal mass.

Symptoms of chronic kidney disease (CKD) include:

  • reduced appetite
  • vomiting
  • bone discomfort
  • headache
  • impaired growth
  • general feeling of discomfort (malaise)
  • excessive or absent urination
  • recurrent urinary tract infections (UTI)
  • urinary leakage
  • pale skin
  • unpleasant breath
  • hearing difficulties
  • abdominal mass
  • tissue swelling
  • restlessness
  • poor muscle strength
  • altered mental state

Haemodialysis and Peritoneal Dialysis are two types of Renal Replacement Therapy (RRT) utilised for paediatric patients with kidney failure, aiding in the removal of waste products and excess fluid from the bloodstream.

Haemodialysis is usually performed in a hospital setting and involves placing a specialised access called an arteriovenous (AV) fistula through a minor surgery. This fistula serves as a connection between an artery and a vein for dialysis, generally in your child’s arm. Once access is established, your child will be connected to a large haemodialysis machine. Blood is circulated through the tube into the machine, where filtration takes place to remove waste products and excess fluid. The filtered blood is circulated back to your child’s body. 

Yes, you can perform Dialysis for your child at home. Performing Peritoneal Dialysis in a home-based setting is simple and easily adjustable. It involves utilising the peritoneum, the lining of the abdominal cavity, to filter the blood. Initially, a surgeon inserts a thin, flexible tube known as a catheter into your child’s abdomen. Once the catheter is in place, a sterile cleansing solution called dialysate is introduced through the catheter into the peritoneal cavity. The dialysate remains in the abdomen for a specific duration, during which it absorbs waste products through the peritoneum. The dialysate is then drained from the abdomen, measured, and discarded. This process of introducing and draining the dialysate is called exchange.

The reason your child’s doctor is recommending CRRT is usually due to acute kidney injury (AKI) and fluid overload (FO). CRRT is also used in the removal of toxins and for those with multi-organ failure.

CRRT is a method of dialysis treatment that is continuous compared to Haemodialysis and Peritoneal Dialysis. The method helps in the gradual and steady filtering and cleaning of your child’s blood by removing waste products and extra fluids. The CRRT method is typically performed 24 hours to several days and is commonly addressed to paediatric patients with severe AKI.

Before the CRRT procedure, a sterile central venous catheter (CVC) is inserted into one of any three large veins present in the chest, neck, or groin. Your child is then connected to the CRRT machine and will remain connected continuously, with specially trained ICU nurses overseeing the operation. The machine mimics some of the functions normally done by normal kidneys. As your child’s condition improves, your child’s specialist may attempt a period without CRRT to assess kidney function. In case it needs to be resumed, the CRRT procedure is done once again, or your child may be transitioned to a less frequent form of dialysis. Your child’s medical healthcare provider would consult and discuss the next course of action regarding your child’s Dialysis.

Possible complications that a child might face due to kidney disease include:

  • Reduced blood cell count (anaemia)

  • Cardio and vascular problems

  • Bone-related ailments

  • Bone, joint, and muscle discomfort

  • Decline in cognitive function, leading to extreme confusion and cognitive impairment

  • Nerve damage in the extremities

  • Increased risk of infections

  • Malnutrition

  • Changes in skin condition, such as dryness and itchiness

CRRT is intended as a temporary measure, with the expectation that the kidneys will eventually recover and return to normal function. The duration of CRRT depends on the tolerance of a child’s treatment and other medical conditions they may have. Your child’s doctor would assess your child’s response to the treatment and assist you in making a well-informed decision.

Home Bhubaneswar Specialities Paediatric-intensive-care-unit Renal-replacement-therapy

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