Author/Editor		Elzouki, Abdelaziz; Carroll, James; Butinar, Dušan; Moosa, Allie
Title		Improved neurological outcome in children with chronic renal disease from infancy
Type		članek
Source		Pediatr Nephrol
Vol. and No.		Letnik 8, št. 2
Publication year		1994
Volume		str. 205-10
Language		eng
Abstract		Progressive encephalopathy, developmental delay, microcephaly, electroencephalogram (EEG) and computed tomographic (CT) scan abnormalities have been reported in 80 percent of children with chronic renal failure (CRF) in infancy. Malnutrition, aluminium intoxication and psychosocial deprivation are proposed as causes. In 15 children with CRF from infancy we evaluated the effect of no aluminium salts and early vigorous nutritional and psychosocial support, in addition to the standard therapy, on neurological development. Six patients underwent dialysis (2 at birth) and 3 received transplants. None of our patients were given aluminium therapy. The nutritional status of the patients in the first 2 years of life was assessed with the waterlow classification. At the end of the follow-up period (mean 50 months range 14-148 months), patients underwent neurodevelopmental assessment, head CT scan, EEG, nerve conduction velocity (NCV) and auditory brain stem evoked response (ABER). None of our patients developed progressive encephalopathy or recurrent seizures. All have a normal neurological examination apart from hypotonia. Microcephaly was present in 5 patients. There was a good correlation between malnutrition in the first 2 years of life and microcephaly. Developmental delay was present in 3 patients; all 3 were microcephalic. There was evidence of brain atrophy on CT scan in only 3 patients. EEG was abnormal in 6 patients, but only severe in 1 patient. Only 1 patient had diminished NCV; all patients had a normal ABER. We conclude that a policy of no oral aluminium therapy and early nutritional support leads to better neurological outcome in children with CRF from infancy.
Descriptors		CENTRAL NERVOUS SYSTEM CHILD DEVELOPMENT KIDNEY FAILURE, CHRONIC BRAIN DISEASES HEMODIALYSIS INFANT INFANT NUTRITION INFANT, NEWBORN KIDNEY TRANSPLANTATION PROGNOSIS TREATMENT OUTCOME