CASE STUDIES
Help me doctor, which renal replacement modality is best for me?
By W. Van Biesen
In view of the young age of the patient, and the absence of any co-morbidity, a living related donation is put forward as a first option and both parents are screened as potential donors. The father, a heavy smoker, is found to have severe hypertension, with proteinuria and a shrunken kidney on the right side. It is obvious that he cannot be considered as a potential donor. The mother, who has a minor form of osteogenesis imperfecta, is found to have microalbuminuria. Her creatinine clearance is measured to be 65 ml/min. No clear explanation for this mild renal dysfunction is found, as she refuses further investigations as her daughter makes it clear that, under these circumstances, she is not willing to accept a donation from her mother.
The patient is listed on the cadaveric donor waiting lis,t and meanwhile, the option is taken to place her on peritoneal dialysis.
A peritoneal dialysis catheter is inserted under local anesthaesia, and after 10 days, peritoneal dialysis is started, and the temporary haemodialysis catheter is removed.
A peritoneal equilibration test (PET) was was performed after 2 weeks. The patient is found to be a low average transporter with a D/P creatinine of 0.65 after 4 hours. She has minimal residual renal function with a creatinine clearance of 1.5ml/min and a diuresis of about 500ml/day. Her body weight is 65 kg.
