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Encephalopathy in children with chronic renal failure
Insights
Children with chronic renal failure developed encephalopathy, possibly linked to aluminum antacids and hyperparathyroidism. Reducing aluminum intake and reconsidering parathyroidectomy may prevent this neurological condition.
Area of Science:
- Pediatric Nephrology
- Neuroscience
- Toxicology
Background:
- Progressive encephalopathy in children with chronic renal failure mimics adult dialysis encephalopathy but is not dialysis-related.
- Renal osteodystrophy is more severe in children, often treated with aluminum-containing antacids.
- Secondary hyperparathyroidism is common in pediatric chronic renal failure.
Purpose of the Study:
- To investigate the cause of progressive encephalopathy in children with chronic renal failure.
- To explore the role of aluminum ingestion and secondary hyperparathyroidism in pediatric encephalopathy.
- To suggest alternative management strategies for chronic renal failure in children.
Main Methods:
- Clinical observation of 5 children with chronic renal failure and encephalopathy.
- Analysis of the association between aluminum antacid use, secondary hyperparathyroidism, and encephalopathy.
- Implementation of reduced aluminum compound dosage and parathyroidectomy in affected patients.
Main Results:
- Encephalopathy in children was clinically similar to adult dialysis encephalopathy but not linked to dialysis.
- Reduced aluminum compound dosage (50-100 mg/Kg/day) was implemented over 18 months.
- No new cases of encephalopathy occurred after dose reduction and parathyroidectomy recommendation.
Conclusions:
- Oral aluminum ingestion, particularly with persistent secondary hyperparathyroidism, may cause encephalopathy in children with chronic renal failure.
- Alternative methods for phosphorus control and reevaluation of parathyroidectomy indications are recommended.
- Lowering aluminum intake and surgical intervention appear effective in preventing further cases.
Abstract:
The progressive encephalopathy observed in 5 children with chronic renal failure was clinically similar to the so-called dialysis encephalopathy of adults, except that it was not related to dialysis therapy. Renal osteodystrophy is more prevalent in children than in adults and often more severe. The attempt to control the crippling deformities of renal osteodystrophy in growing children with renal insufficiency has led to the use of large quantities of aluminum containing antacids. The encephalopathy observed in children with chronic renal failure may be related to the oral ingestion of aluminum containing compounds in the presence of persistent secondary hyperparathyroidism. We suggest that alternative methods for the adequate control of serum phosphorus levels should be sought and indications for parathyroidectomy in children reevaluated. During the past 18 mos we have lowered the dose of aluminum containing compounds to 50 to 100 mg/Kg/day in our patients with progressive renal failure and recommend parathyroidectomy. No new cases of the encephalopathy have occurred.