[Experience with long-term care of dialyzed children and children with kidney transplants].

By the increasing number of children with terminal renal failure the experience in the care of these patients has grown. In this paper the treatment of 197 children with chronic renal insufficiency observed from 1969 to 1980 at the University Children's Hospital in Heidelberg is summarized. A concept of integrated care adjusted to the stage of the disease was adopted. Emphasis is given to obtain a smooth transition from one therapeutic stage (conservative treatment, hospital dialysis, home dialysis, transplantation) to another. The clinical course of the patients including death is presented. The main medical and psychosocial problems arising at the end-stage of renal failure are discussed: the indications for continuing therapy, the choice of vascular access for dialysis and the form of dialysis treatment. The advantages of home dialysis as well as its stress on child and parents are underlined. The main role of dialysis is to prepare the child for transplantation and to replace renal function in the meantime. In spite of the obvious advantages of transplantation in allowing an improved quality of life, the somatic and psychologic stress involved should be kept in mind. We conclude that during all therapeutic stages passed by children with chronic renal failure a preventive approach should be favoured from the clinical as well as from the psychological point of view.