Arterial changes in paediatric haemodialysis patients undergoing renal transplantation

The relationship between primary renal disease and arterial wall changes in paediatric haemodialysis patients has been little studied. The aim of the present work was to determine the influence of primary renal disease on arterial wall pathology in uraemic paediatric patients.

Twelve paediatric haemodialysis patients (seven girls, five boys) aged 11-17 years were included in the study. The primary renal diseases were urinary malformations in six patients (uropathy group) and acquired glomerular diseases (glomerulopathy group) in six patients. Age, sex distribution, duration of chronic renal failure, duration of haemodialysis, blood pressure, serum glucose, triglycerides, cholesterol, fibrinogen, calcium, phosphorus and parathyroid hormone levels were compared. Internal iliac artery samples were obtained at the time of related-donor renal transplantation. Artery samples were fixed in formaldehyde and sections were stained separately with haematoxylin and eosin, Orcein, Verhoef-van Gieson, and Masson trichrome.

Five arteries had fibrous or fibroelastic intimal thickening, medial mucoid ground substance and disruption of the internal elastic lamella. Two of these had microcalcification in the intimal layer; another two demonstrated atheromatous plaques; the remaining five were normal. These pathological changes were found in the arteries of all six patients with uropathy, whereas of the six patients with glomerulopathy only one had arterial changes (P<0.001). The duration of chronic renal failure was 4.8+/-1.9 years in the uropathy group and 2.2+/-1.2 in the glomerulopathy group (P<0.05). The two groups were comparable in terms of serum glucose, triglycerides, cholesterol, fibrinogen, calcium, and parathyroid hormone levels, presence of hypertension, sex distribution, and duration of haemodialysis. Plasma phosphorus and the calcium x phosphate product were higher in the uropathy group than in the glomerulopathy group (P<0.05).

This study demonstrated that pathological changes are common in the arteries of uraemic paediatric patients, and that calcification and atherosclerosis are integral to this disease process. In our study, these alterations were more common in the patients with uropathy. We speculate that the patients with uropathy are more prone to these alterations due to slower progression and a longer duration of renal insufficiency.