We report the case of a Lebanese infant born by normal delivery at 40 weeks of gestation. Weight and height at birth were 3200 grams and 49 cm respectively. Serum
creatinine in the first week of life was 323 mmol/l (normal value for age is less than 20 mmol/l). Kidney ultrasound confirmed diagnosis of hypoplastic small kidneys.
Conservative treatment of
renal failure was initiated from the first days of life.
Conservative management of
renal failure included careful attention to fluid balance, maintenance of adequate nutrition and correction of
hyperkalemia,
acidosis,
hyperphosphatemia and prevention of
renal osteodystrophy by the use of dietary
phosphate binders and
vitamin D analogs. After a slight decrease of serum
creatinine in the first three months of life, creatininemia increased progressively despite
conservative treatment associated to
hyperkalemia and severe
pruritis due to
hyperphosphatemia. Faced with the progression of
renal failure, we decided to start automated
peritoneal dialysis at seven months of life. Weight and height were respectively 6200 g and 63 cm. Serum
creatinine was 432 mmol/L.
Pruritis improved after starting
peritoneal dialysis as well as appetite. At 20 months of life and a weight of 9.7 kg, a familial kidney transplant was performed. Immunosuppressive treatment included SimulectO, on day 1 and day 4, associated to
mycophenolate mofetil, tacrolymus and
prednisolone. The immediate post-transplant period was complicated by urinay tract
infection due to BSLE E. coli. After four episodes of
urinary tract infection due to resistant E coli associated to a non obstructive stone of 15 mm in the allograft kidney, we performed two sessions of
lithotripsy and placed a double J
stent. Biochemical urinary analysis did not reveal any causes for
lithiasis. Stone disappeared as well as
infection after
lithotripsy. Renal function is normal for age one year after the kidney transplant. To our knowledge, this is the first reported case of a successful kidney transplant in a Lebanese infant with
kidney failure since birth with kidney transplant performed at less than 10 kg of weight on the transplant day.
Peritoneal dialysis is the treatment of choice for infants with
chronic kidney failure. Familial or cadaveric kidney transplant should be encouraged and performed even in infants weighing less than 10 kg allowing them to have normal growth as well as social and school integration.