???? ?????? ????????? ?????, ?????, ?????? ???, CAPD

1
???? ???? ???? ???? ???????? ??????????? ????
?????? ????

• ?????? ???? ???????
• ???? ?????? ????????? ?????, ?????, ?????? ???,
  CAPD
• ???? ?????? ???? ???
• 12/2009

2
???? ???????

• ?. ?., ???? ?? 1/2 3 ???.
• ?????? ???????? ???? 3 ??????.
• ????? ??????, ?? ????? ?????,??? ???? ???? ??????
  
• ???? ????? ?- 3 ????, ?????
• ?? ?? ???????, ????!
• ???? ????? ????? ?????? ?????
• ???? ????? ?? ??? ?? ??????? ???? ?????
• ???? ????? 2990 ???

3
???? ???? ?????

• ????? (???? ????? ???), ????? ????? ????? ???????
  ???? ?????
• 5 ???? ???? ?????, ???? ??????, ?????? ?????
• ???????? 195/???, ?''? ???? 23/14 ,???????
• ????? ?????? ?????? ????? ????? ????.
• ??? ???? ??????? ??? ???????? ?????? ??
  ??????? CNS , ?????, ???, ???????? ??????????,
  DIC , hypoxic ischemic encephalopathy ,
  hypothyroidism (????)

4
???????

• ??????, ?????????
• ???? ????? ??????
• ????? ???? ???? ? 3 ?''?/ ?''?/???, ??? ????
  ?????? 2 ?''? ?????!
• BUN ??? ?? 240 ?'? !
• US ????? ????? ?????????, ????? ?? ?????? ???.
• ???? 3 ?????? ?????? ????? ?????? ???? ????? ???
  ????? ????? ????????.
• ??? ?????? ??????? ????

5
??????

• ??????, ????? ????? (RLL ) ???? ???????, ????
  ???????.
• ?????????? ?????, ????? ???? ????? ?????? ?
  withdrawal . CT ??? ???? 3 ???? ??? ????
• CT ???? ???? 3 ?????? ?? ????? ????? ????
  ??????? ?? ??? ?????? ????
• US ????? ????? ?? ??????, ????? ???????? ??????
  .
• ????? ???? ??????????? RIJ ????? ??????.

6
?????? ?????????

• ???? ???? ??? ???? ??? ??? ?????? ?????, ??????
  ???? ???? ??????
• ???? ????? ????? ???????? ????? ???? ????? ??
  ??????, ???? ????????? ?????, ????? ????
  ?????????.
• ??? ???? ?????? ????? ???????? ?? ?? ?????? ????
  ?? ??? ?????????? ???? ??.
• ???????? ???? ????? ?????????? - ????? ????
  ??????????- ????? ???, ?????? ????????? ????????
  ?????? ?????.
• ????? ?????? ??? ???? ????, ????? ????? ??? ?????

7
?????? ???????

• acute tubular necrosis/acute cortical necrosis
• ???? ???? ??????? ??? ?????? ???? ?? ????.

8
???? ???????????

• ???? ????? ??? ????? ????? ????? ???? ?? ??? PEG.
  
• ??????? ?????? ??????? ?????????? ?????? 4 ????
  ?????
• ????? ??? ?????????? ??????, ?????, ??????,
  ?????? ????? ??????
• ????? ??????????? ?''? ???? ????, ???? ??????
  ????? ????? ??? ?????? ?? ???????
• ????? ????? ?? ???? priming ?? ?? ??? ?????, ????
  ????
• ???? ?????????? ????? ???????? ???????

9
????? ???????? ???????????

• ???? ??????? ????? ?????? ??????? ???? ????????
  ?????
• ?????? ???? ?? ??? ????? ?????? ???? ???? ?????
  ??? ????? ??? ???? ?????(?) ,??????? ?????,
  ?rota virus- ?? ??? ????.
• ? - 23/11/2006 ????? ???? ??????
• ???? ??? 4.5 ?''? ?????? PD
• ?????? ?? hep/saline 20-30 CC X 3 q2days
• ??? ????? ????? ?????? ???? ?????? ???????????

10
?? ????? ????? ??????Pediatric Nephrology 6th
edition, 2009E. Avner, W. Harman, P. Niaudet, N.
Yoshikawa

• CAKUT - Congenital anomalies of the kidney and
  urinary tract aplastic, hypoplastic, dysplastic
  kidneys
• reflux nephropathy
• ) together 47!)
• FSGS
• Polycystic kidney disease
• Hereditary kidney diseases PH
• -
  atypical HUS
• -
  Cystinosis
• -
  Congenital Nephrotic Syndrome
• Acquired kidney disease MPGN, SLE

11
?????????? ???????? ??????

• ???? ??? (??????????) ????? ???? ???-??, ??-?????
  ???, ????
• ???????? (????? ?????? ?????? ??????) ?????????,
  ???? ???????, ????????????...
• ???????? ??????? (????? ??????, ??? ?? ???,
  ?????? ??????, ????? ???????????)
• ?????????? ??????
• ?????? ????? SCR ???? ???? (????? ?? CREAT 4 ???
  ???''? ??????!)
• ????? ???????? ?????? ????? ???????? ?????
• ?????

12
PD ??????

• Article in International Urology and
  Nephrology, 2009, Oreopoulos, et.al. states
  home peritoneal dialysis is a better option than
  in-center hemodialysis in young children
• Peritoneal Dialysis, A Guide to Clinical
  Practice, EDTNA/ERCA 2009 states PD is
  accepted as a distinguished dialysis model in
  pediatric patients

13
PD ??????

• ???? ???? 1940 ?? ????
• ?????? ???? ???? ?????? ??? ???? ???? ????
  ??????
• ???? ?????? ????? ??? ???
• ??? CC 40-50 / ?''? ?? ??? ????? ?? ??? ???
  ????? ??? ??? ???? ????? ????!
• ?????? ???? ?????? ???? ????, ?????? ?? "?????"
• ????? ???? ???????? ???
• ???? ???? ???????? ??????? ??????
• ????, ?''? (!), ???, ???? (X1/????),
  ???? ??? , ???? ???????, ???? ???????, ???? ????
  ???? ????????, ?????, KT/V, PET
• ??????????, ??????, ??? ?????, ????????????

14
???? ??.?.
15
???? ????? PD ?? ?.?.

• ?-??????? ???? ????? ??????? - D1.5 X CC 100 ??
  ???? ???? ?????? ?? 200CC X 7 ?sleep safe , ½ 10
  ???? ????? ????? ? 4 ????.
• ????? ?????????? ????? 28/12/2006 !
• ?-CL ??????????? ???? "???? ??????" ????
• ?? ???? ????? ???, CL ???? ??? ??? ????? ????
  ????? ??? ??? ?? ??
• ??? ???? ???? ?????
• ??? CL ???? ??????

16
?????

• ???? ????? ??? ??? ?????? ????? ?????????? ?? ???
  ? CL ?? ??????
• ???? 8 ??????-????? ?-?.?.?. ??? ????? ???? ????,
  ????? ????? ?????, ??? "?? ???", ??????? ????????
  ??? ??????
• WBC 27,000 (???? 3,6000-10,000) , PLT 70.000
  (???? 150.000-450,000 ), ?''? 50/30, ???? 180 ,
  ?????? 36 , 2O SAT 94
• ????? ???????????, dopamin ????? ?''?, ?? ?????
  ????? ????! ??? ???? ????? ????? (??? ???)
• ????? CL
• ???? ??? ??? ????, ??????? ??.?.?. ??????? ????
  ?????? PD .

17
???? ???? PD

• ???? ????????? ???? ?????????!
• Fine tuning ?? ????? - CC 500-600 similac 60/40
  polycose ????????, ?????? ????
• ????? ?????? PD ?? ????????
• ???? ??? (1/2 ??? ? PD ) 8.6 ?''?
• ????? ??????? ?????? ???? ???? ?????? ??????.
• ????? ?? 2.5 D ?? ??? ???? ???? UF ????? ?????
• ???? ?????? ????? ???? 10 ?''?!
• ???? ???? ????? ?????? ????? ???? ??? ?? ??????
• ???? ???? ???? ?????? ????? ?????
• PD CC 390X 8 , ????? ????? CC 380 ?- 5-7 ?'

18
?????

• ????? ?????? ????? ?????
• ???? ????????
• ????? ????????, ??????????
• ?????????? X3 /???? ?''? ?????? ?? ??? ????,
  ?? ?????? ??-? (?????) ?????? ??????-???????
  ?????, ????? ??? ?????? ?? ??????
• ?????? ?????? 5/2008
• ???? ?????? ??????
• 11/2008 ????? ????

19
???? ?? PD

• ?????? ??? ????? ??????
• ????? ?? ?????? ??????? ???? (????? ????? ???'?)
• ????? ?????? ?? ?cycler ????? ??????!
• ???? ?????????, ????? ???????, ????? ????? ?????
  ?????? ???? ?? ?????? ???
• ???? "????????" - ?????? ??? ????? ?? ?. ???
  ??????, ????? ??? ??????...

20
????? ?????? ????

• ?????? ???? ????? -10 ?''? , ???? ??????
• ???? ?????? ???? ???????
• ????? ?????? ???????? ?????? ????
• ????? ????? ?????
• ????? ????? ?????

21
???? ?????? ??????

• 03/11/2009 LRD, ???? ???? ?????? ?????, ?????
  ?? ????
• ?????? ????? JJ
• ???? ????? ????? ???? ??? ???? ?????
• ?????, ????? ?????? ?-12 ???? ???? ??????
• ?????? ?-ATN
• ????? 1 ?? ?????????? ??? PD ?? ?????? ?????!
• ??? ?????? ???? ?????? ??????????

22
???? ???? ??????

• 11/12/2008 ???? ???? ?????????? ?????, ???? ???
• 25/12/2008 ????? ?.?.?. Respiratory failure
  ??? parainfluenza - ?????? ???
• 08/01/2009 ????? JJ ????? ??????
• ??????? ????? ??? ??????? ????? ????
• ???? ??? ???? - 10.130 ?''?, ???? 75 ?''?
• ???? ???? 11 ?''?, ???? 85.5
  ?''?
• ???? - ?????, ?????, ?????? ????!
• - ????? ????? ??????, ??? ??????
• - Creatinine 0.68 mg