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Neurologic development of children with severe chronic renal failure from infancy
M S Polinsky1, B A Kaiser, J B Stover
1Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Insights
Severe chronic renal failure (CRF) in infancy significantly impacts neurologic development, with most affected children experiencing developmental delays, particularly in motor and language skills. Other contributing factors like nutrition and medical treatments also play a role.
Area of Science:
- Pediatric Nephrology
- Developmental Neurology
- Clinical Pediatrics
Background:
- Severe chronic renal failure (CRF) originating in infancy poses risks to neurological development.
- Understanding these effects is crucial for early intervention and management.
Purpose of the Study:
- To review and synthesize current knowledge on the impact of early-onset severe CRF on neurologic development.
- To identify factors contributing to developmental delays in this patient population.
Main Methods:
- Literature review of 95 examinations from 85 patients with early-onset severe CRF.
- Analysis of developmental assessments, head circumference, and clinical data.
- Consideration of factors such as dialysis, transplantation, and comorbidities.
Main Results:
- 63.2% of patients exhibited developmental delay, with higher rates in gross motor and language skills.
- 64.7% had head circumferences below -2 standard deviations.
- No direct correlation found between CRF severity/age at diagnosis and delay prevalence/severity.
Conclusions:
- Early-onset severe CRF is associated with significant neurodevelopmental challenges.
- Factors beyond renal function, including medical interventions and comorbidities, contribute to delays.
- Further research is needed to elucidate specific mechanisms and optimize care.
Abstract:
A literature review was conducted to summarize current understanding of the effects of severe chronic renal failure (CRF), when present from infancy, on neurologic development. Data were obtained from the results of 95 examinations performed in 85 patients, most of whom had been studied after 12 months of age, or following initiation of maintenance dialysis or successful transplantation. CRF was diagnosed at birth or during the neonatal period in 71.7% of these patients; serum creatinine concentrations or calculated clearances were greater than or equal to 2.0 mg/dl (177 mumol/l) or less than 15 ml/min per 1.73 m2, respectively, in 75.8%. Head circumferences were greater than 2 standard deviations below the mean for age in 33 of 51 (64.7%) patients. Developmental delay was identified in 63.2% of all cases, and in 29 of 48 (60.4%), 16 of 19 (84.2%), and 4 of 13 (30.7%) patients studied while receiving conservative management or maintenance dialysis, or following successful transplantation, respectively. Moderate to severe delays were commoner for gross motor and language development. No significant relationships could be identified between age or severity of CRF at diagnosis and either the prevalence or severity of developmental delay. Other factors that may have contributed to observed developmental delays are also discussed, including aluminum loading, hyperparathyroidism, undernutrition, and psychosocial problems. New data are presented and discussed, and recommendations for future studies provided.