Pediatric nephrology : journal of the International Pediatric Nephrology Association
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Continuous venovenous hemofiltration (CVVH) is a technique characterized by a venovenous circuit and a pump to perfuse the hemofilter. CVVH is suited to individualization of ultrafiltration and solute clearance in patients with acute renal failure and volume overload, specifically when there is impaired cardiovascular function or where arterial access is problematic. Examples, indications and relative advantages of this and other dialytic modalities are discussed.
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The rapid development of new techniques in molecular biology is leading to identification of the genes responsible for a wide variety of diseases. Several renal conditions are caused by gene defects and are amenable to this approach. The process of gene mapping is discussed and the current position regarding prenatal diagnosis and carrier testing for genetic renal disease is reviewed.
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A 12-month-old girl with end-stage renal disease secondary to primary oxalosis was erroneously given an overdose of sodium chloride (400 mEq NaCl over 12 h) to treat hyponatremia. She became lethargic and hypotonic with signs of intracellular dehydration, and laboratory values revealed severe hypernatremia and hyperchloremia. Since hypernatremia was acute and development of intracellular idiogenic osmoles was presumably minimal, serum sodium was lowered rapidly over 14 h by hourly peritoneal dialysis using a commercial dialysate. This method of treatment proved to be safe and the patient survived without any short or long-term neurological sequelae.