Pleural effusion complicating acute peritoneal dialysis in hemolytic uremic syndrome

Hemolytic uremic syndrome (HUS) is a leading cause of acute renal failure ( ARF) in children, and one for which treatment with peritoneal dialysis (PD) is often necessary. Between January 1982 and December 1996, 176 children r eceived PD for ARF at St. Christopher's Hospital for Children; 34 (19%) of whom had HUS. Of these 34, 7 (20%) developed pleural effusions (PE) while r eceiving PD, whereas none of the remaining 142 children with other causes o f ARF did so. The mean age of the 7 affected children was 5.2 (range 0.4-17 ) years; none had heart failure or nephrotic syndrome, nor had any of them undergone thoracic surgery. PE were diagnosed by chest radiograph at an int erval of 2 (range 1-3) days after starting PD. Thereafter, 4 (57%) patients were successfully maintained on a modified PD prescription; 2 others were converted to hemodialysis and 1 to continuous venovenous hemodiafiltration. Although PE are a known complication of PD, none of the patients so treate d for non-HUS related ARF developed them. Whether they represent a purely m echanical complication of PD, or are in some way attributable to HUS itself is not entirely clear. Regardless, when children with HUS require PD, phys icians should monitor for the development of this potential complication to minimize the risk of serious respiratory compromise.