THE ROLE OF ECHOCARDIOGRAPHY IN THE MANAGEMENT OF PEMATRIC RENAL PATIENTS (PTS)

Abstract

Accurate assessment of cardiac function (CF), fluid status and pericardial effusion (PE) in children with renal failure is often difficult. The role of echocardiography in the management of these PTS was evaluated by analyzing 112 echograms (ECHO) obtained because of cardiopericardiac enlargement (CPE) on chest x-ray, cardiac murmur not attributable to anemia, changing fluid balance or possible bacterial endocarditis (BE) in 34 PTS. 12 PTS not requiring dialysis (NO DIAL) and 22 PTS on dialysis (DIAL) were studied. The CF and cardiac size were acceptable in all of the NO DIAL PTS and required no change in their therapy. However, 19/22 DIAL PTS had CPE. By ECHO 15/19 had left ventricular volume overload (LVVO) that was not clinically apparent, 5 had PE alone and 10 had LVVO and PE. Routine dialysis, antihypertensive drugs and diet restriction resulted in improvement of the clinical and ECHO findings in only 8. The remaining 11 PTS had persistent decreased CF on ECHO, with 6 requiring intensive ultrafiltration, 5 digoxin, and 1 of the 5 closure of an A-V fistula to improve CF and PE. One DIAL PT in whom an ECHO was done to rule out BE had hypertrophic cardiomyopathy without evidence of vegetation. An ECHO in another PT with rapid deterioration revealed a large mitral valve vegetation that had developed in 30 days, identified as Candida albicans at autopsy. Hence, echocardiography provided valuable information about fluid status and CF, and significantly aided the clinician in caring for the children with renal failure.