Abstract P-237: NEPHROLOGY CARE IN PEDIATRIC INTENSIVE CARE UNIT (PICU): EXPERIENCE OF PEDIATRIC NEPHROLOGY CENTRE OF HONG KONG

Abstract

Aims & Objectives: To share our experience with renal support in intensive care settings in our nephrology centre. Methods Retrospective review. Results As the only tertiary referral center of pediatric nephrology in Hong Kong, as well as a regional tertiary center for PICU, from the year 1997–2017, we encountered more than hundreds of patients admitted to our PICU requiring renal support, with top diagnoses being 33 nephrotic syndrome, 25 systemic lupus erythematosus (SLE) and 21 hemolytic uremic syndrome (HUS). Nephrotic syndrome is often complicated by hypovolemic shock or acute renal failure requiring dialysis support. SLE can present as nephritis with renal failure, severe autoimmune hemolytic anemia or cerebral involvement. HUS in our locality is caused by pneumococcal pneumonia, which can lead to septic shock, pleural effusion, respiratory failure, and acute renal failure. Being the only pediatric renal transplant center in Hong Kong, we also managed 16 renal transplant cases admitted for post-operative care or transplant-related complications. We also encountered 12 severe peritonitis and 5 hypertensive encephalopathy. For procedures, continuous veno-venous hemofiltration (CVVH) (n= 17) remained the most important temporary renal replacement therapy for acute renal failure in intensive care setting. Recently we encountered a case of severe adenovirus pneumonia leading to secondary cardiopulmonary arrest with acute kidney injury. She was anuric post-resuscitation requiring CVVH for 41 days with eventual return of normal urine output and renal function. Plasmapheresis is another common procedure, which is useful for a wide range of conditions including toxic shock syndrome, HUS, SLE, inflammatory neurological conditions like Guillain-Barre etc. Conclusions As above.