PubMed · 14812784
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JEANBRAU, TRUC, LAVAL. 1951-02-10. [Anuria therapy].. https://pubmed.ncbi.nlm.nih.gov/14812784/
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Diagnosis and treatment of an anuric premature infant with severe respiratory compromise and a normal renal ultrasound (US), is a difficult task that requires a multidisciplinary approach. A 29-week gestation premature male infant, born after 5 weeks of worsening oligohydramnios, was ventilated for respiratory distress and remained anuric. Intensive clinical investigations and pediatric nephrology consultation that predicted very poor prognosis were followed by progressive renal failure, electrolyte imbalance, respiratory failure, ventricular arrhythmia, and finally cardiac arrest and death on day 5. In view of the predicted poor outcome, and after discussion with the parents, a decision was made not to start peritoneal dialysis (PD), and to offer only palliative therapy, with comfort care alone. Pre and postnatal diagnosis lead, in this case, to an ethical challenge that focuses on the question of futility.
The article by Ni et al. solidifies the important role of aquaporin-1 in the process of fluid removal from anephric patients treated with peritoneal dialysis. The presence of the water-only channel in the subperitoneal endothelia provides the mechanism for solute-free ultrafiltrate observed early in dialysis and accounts for approximately half of all the filtration observed in dialysis.