The use of an improvised nasogastric tube as a peritoneal dialysis catheter and challenges of adaptation-a case report

Background: Paediatric dialysis for acute kidney injury (AKI) in developing countries may be a challenge because of limited access to standard gadgets. Adapted gadgets such as nasogastric tubes have been used to provide peritoneal dialysis (PD)in such settings. The nasogastric tube is usually inserted by the trocar or surgical technique which is cumbersome. We describe passage of the nasogastric tube for PD at the bedside by a technique that is considered easier than the trocar or surgical method. Case report and Treatment: A two-and-a-half-year-old girl presented with oliguric AKI secondary to malaria and intravascular haemolysis with suspected uraemic encephalopathy. Her serum creatinine on admission was 9.4mg/dl. A nasogastric tube was adapted as PD catheter, and was inserted by the modified Seldinger technique on post-admission day 1. Results: She received 39 cycles of PD over 5 days. Complications of PD included catheter outflow obstruction on post admission day 2 on account of which the catheter was replaced. She also developed Klebsiella pneumoniae peritonitis and on account of which the procedure was discontinued on post admission day 6. She regained normal urine output on post admission day 7. She was managed with iv meropenem based on the antibiotic sensitivity pattern with resolution of peritonitis. She showed significant improvement and her serum creatinine on post admission day 15 was 0.5 mg/dl.She was discharged home on post admission day 18. Conclusion: Nasogastric tube, adapted as PD catheter and inserted by modified Seldinger technique may be life-saving in patients with AKI in developing countries. Keywords: Peritoneal dialysis, acute kidney injury, nasogastric tube, developing countries, childre

Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities

Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non-governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services. Keywords: Peritoneal dialysis, children, developing countries, sub-Saharan Africa, Nigeria, acute kidney injury, end-stage renal disease

Recurrent Urinary Tract Infections in a Child with a Duplex Renal Collecting System - A cas Report & Literature Review

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An Unusual Case of Severe Varicella Zoster Infection Complicated by Acute Renal Failure in an 8-year-old Nigerian Boy

Background: Varicella zoster virus (VZV) infection is highly contagious and has a worldwide distribution. It is predominantly a childhood disease and frequently runs a benign course. However, serious complications such as target organ damage could occur in older immunocompetent children. Acute kidney injury (AKI) arising from varicella infection is one of the rare complications in children. Case Report: The patient presented with body rash typical of varicella, fever, cough, difficulty in breathing, vomiting and dark urine. He had contact with his two siblings with similar rashes. He was febrile, centrally cyanosed with generalised lymphadenopathy and body rashes at different stages of development. He had tachypnoea, dyspnoea and widespread coarse crepitations. Kidneys were enlarged and urinalysis revealed microscopic haematuria of 4+ and proteinuria 1+. Initial assessment of chickenpox with pneumonia and nephritis was made. He received oral acyclovir among other interventions. His estimated glomerular filtration rate dropped from 120 to 8.71mls/min/1.73m2. He had 3 sessions of haemodialysis, his biochemical parameters normalised and has been on follow-up for one year with normal renal function. Conclusion: Acute varicella infection can lead to clinically significant kidney failure in otherwise healthy children. Prompt renal replacement therapy could result in complete recovery of kidney function