?????34%

1
? ? ? ? ? ?

• ????????????????

2
????????????

• ????? 34
• ????(?????????) 22
• ????????? 16
• ???????? 11
• ?? 12
• ?????(Wilms tumor)
• ?????
• ?????

3
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4
????????????
??? ??() ??() ??()
??? 1-12?? 1-4? gt4?
?????? 38 65.8 19.5 14.6
????? 9 21.0 26.3 52.6
????? 16 0 17.6 82.4
???????? 31 50.8 30.8 18.5
?????? 4 12.5 50 37.5
????? 1 100 0 0
?? 1 0.3 0 0.7
5
PD
HD
6
??????????

• ???????????20??
• ????? 36????
• ?????????33mmHg?
• ???????(GFR)-
• GA28?? 10ml/min/1.73M2
• GA38-40?? 20ml/min/1.73M2

7
??????????

• ???Cr?????????
• ???Cr??????
• ???Cr???????????Cr????
• ????????????

8
??????

• ????????2-3.5/????/???
• ???????
• ??????
• ????????
• ??, ????????
• ?????

9
??????

• ??
• ??????????????????????
• ????
• ?????????????????????????????????????????????

10
? ? ? ? ?(??)???????????

• ???(oliguria)??48???
• ???????
• ?????????
• ????????
• ????(BUNgt150mg/dl)?
• ?????????

• ????????????
• ??????
• ???????
• ???????
• ??????

11
? ? ? ? ?(??) ???????????

• ????
• ????,????,???,???????
• CCr lt 10 ml/min/1.73m2????????
• ??????????
• ??Crgt10mg/dl (???) gt5mg/dl (lt4?)?
• Hblt6g/dl?
• HCO3lt10mg/dl?
• ??Pgt10mg/dl?

12
?????????

• ???? (???????)
• ????single needle method?
• ??????(shunt)
• ????? ??????????????? ????????????????
• ?????(fistula)
• ?????? ??????? ???????????
• ???? ????(???) ???Dacron, PTFE, Plasm TFE?

13
AV fistula 20
AV graft 17
External catheter 63
14
?????????

• ???????
• ???
• ??????????????
• ????????
• ??????????
• Hickman catheter?????
• ???
• ??????????
• ????????
• ???????

15
??????????????

• ????????
• ?? ??????????
• ?????????
• ?????
• ??????????
• ????????
• ??????

16
External catheter
A-V fistula
A-V graft
?????????????
17
??????????

• ???? priming volume, clearance efficiency, and
  low compliance.
• ?????? lt 8-10??????????
• ???????????20ml (BWlt5kg)
• ??????????40ml (BWlt8-10kg)
• ??????????73ml
• ???????????100ml (BWgt40kg)

18
(No Transcript)
19
?????????

• ????(BF)
• BWlt10kg BFlt100ml/min
• BW10-40kg BF2.5?BW100
• BWgt40 BF250ml/min
• ??????40-120ml ???150-300ml
• ?????(Sequential dialysis)?albumin (25) infusion
  (1-2g/kg ?HD?????)?????

20
?????????

• Heparin dose ???10-15U/kg ???? 5-10U/Kg/hr

21
?????????

• ?????(????????)
• BUNlt100mg/dl lt3ml/min/kg in children
• BUN 100-200mg/dl ????? mannitol(20) 1g/kg
  (??30????????1??)
• BUNgt200mg/dl lt1.5ml/min/kg
• ????????????6-8???????400mmHg?

22
?????????

• ??????
• ?????3?????,?????2???????????3, 4???
• ??????(???)
• NFK-DOQI ? 1.4
• URR 65

23
???????? ??

• ??? 20-30
• ?? ?????????????????????
• ??????????????(lt5)?????????????Na???????,0.9
  ?????,albumin 0.5-1g/kg,?20 mannitol?

24
????????? ??

• ????????
• ???????????????????????????????? ??? ??
• ?????
• ???
• ?????????????

25
???????? ??

• ????
• ????????Bleeding tendency
• ???
• ????
• ???????????????
• ???????????

26
???????? ????
??? ????
??? 4/10???? 3-5/100???
?????? ??20-30??? ???60???
?? ???????????? ?????
??? ????? ????
?? ????????? ??
27
???????? ??

• ??
• ????
• ????????
• ?????????
• ?????
• ?????
• ?????
• ??????

28
???????? ??

• ????
• ????????????????????????????????????..?
• ?????
• Chronological age ????bone age
• ???????bone maturation spurt,?linear growth
  spurt??????
• ????
• ????

29
(No Transcript)
30
Criteria to investigation of short stature

• Height more than 1.5SD below the midparental
  height
• Height more than 2 SD below the mean and 1 1-year
  height velocity more than 1 SD below the mean for
  chronologic age or (in children 2 y/o age or
  older) a 1-year decrease of more than 0.5 SD in
  height
• In the absence of short stature, 1 1-yr height
  velocity more than 2SD below the mean or a 2 yr
  height velocity more than 1.5SD below the mean.

31
Criteria to investigation of short stature

• Children with height less than 3rd percentile for
  chronologic age with chronic renal insufficiency
  (Chronic renal insufficiency is defined as a
  serum Cr of less than 30 mg/dl or a Ccr between 5
  and 75ml/min per 1.73 m²)

32
GH therapy - recommendations

• Existing metabolic derangements should be
  corrected
• Begin with dosage of 0.35 mg/kg/week, divided
  into daily or 6-times-per-wk sc injection.
• Treatment is continued until final height or
  epithyseal closure has been documented.
• Not recommended for post-transplantation

33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
?????????

• ?????????,??????????????