Persistent hypoglycemic attacks during hemodialysis sessions in an infant with congenital nephrotic syndrome: Questions

Excerpt

A 5-month-old female infant was referred to our clinic to maintain her chronic hemodialysis (HD) program. She was born 3100 g at 38th week of gestational age from fifth-degree consanguineous parents. She was diagnosed with congenital nephrotic syndrome (CNS) at the age of 2 months and treated with albumin infusions and diuretics. Biopsy showed mild mesangial cell proliferation in glomeruli, dilatation of tubules, and hyaline degenerations in arterioles. At the age of 3.5 months, the patient was hospitalized for sepsis, seizures, severe pulmonary edema, and kidney failure. Lumbar puncture revealed no signs of meningitis, and cranial MRI findings were normal. She was treated with continuous renal replacement therapy and broad-spectrum antibiotics, as well as phenobarbital. High-dose vasopressor therapy was required due to septic shock and hydrocortisone was empirically started. Thyroid hormone replacement was used for hypothyroidism. After the stabilization of clinical status, chronic peritoneal dialysis was started. After 1 month of peritoneal dialysis, the patient was required to switch to HD due to fungal peritonitis and was then transferred to our clinic. …