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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Brain abnormalities in children and adolescents with chronic kidney disease
Mina Matsuda-Abedini1, Kevin Fitzpatrick2, Waverly R Harrell3
1Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. mina.matsuda-abedini@sickkids.ca.
Insights
Brain abnormalities like white matter injury are common in children with chronic kidney disease (CKD). This study highlights the need for brain imaging in pediatric CKD patients to identify risks.
Area of Science:
- Pediatric Nephrology
- Neurology
- Radiology
Background:
- Chronic kidney disease (CKD) is a known risk factor for vascular disease and stroke.
- The extent of brain injury and white matter abnormalities in children with CKD remains largely uncharacterized.
Purpose of the Study:
- To investigate the prevalence of brain injury and microstructural white matter abnormalities in children with CKD.
- To compare white matter microstructure between children with CKD and healthy controls.
Main Methods:
- Cross-sectional study involving 29 children with CKD and 20 healthy controls at two North American pediatric hospitals.
- Conventional brain MRI and diffusion tensor imaging (DTI) were used to assess brain injury and white matter microstructure.
- Tract-based spatial statistics (TBSS) analyzed fractional anisotropy (FA) maps to compare white matter integrity.
Main Results:
- Focal and multifocal white matter injury was observed on brain MRI in 21% of children with CKD.
- CKD subjects exhibited reduced white matter fractional anisotropy and increased diffusivity in the anterior limb of the internal capsule compared to controls.
- These findings suggest potential abnormalities in myelination in pediatric CKD patients.
Conclusions:
- Cerebral white matter abnormalities are under-recognized in pediatric CKD.
- Further longitudinal brain imaging studies are necessary to understand the timing of white matter injury and identify modifiable risk factors in pediatric CKD.
Background:
Chronic kidney disease (CKD) is a risk factor for vascular disease and stroke. The spectrum of brain injury and microstructural white matter abnormalities in children with CKD is largely unknown.
Methods:
Cross sectional study at two North American pediatric hospitals. A cohort of 49 children, 29 with CKD, including renal transplant (mean age 14.4 ± 2.9 years; range 9-18), and 20 healthy controls (mean age 13.7 ± 3.1 years; range 9-18) had their conventional brain magnetic resonance images (MRIs) reviewed by one neuroradiologist to determine the prevalence of brain injury. Fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) were generated to compare white matter microstructure in CKD compared to controls, using tract-based spatial statistics (TBSS).
Results:
Focal and multifocal white matter injury was seen on brain MRI in 6 children with CKD (21%). Relative to controls, CKD subjects showed reduced white matter fractional anisotropy and increased mean diffusivity and radial diffusivity in the anterior limb of the internal capsule, suggestive of abnormal myelination.
Conclusion:
Cerebral white matter abnormalities, including white matter injury, are under-recognized in pediatric CKD patients. Brain imaging studies through progression of CKD are needed to determine the timing of white matter injury and any potentially modifiable risk factors.
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