The evaluation of cerebral atrophy in renal dialysis patients by computerized tomography

Association between renal function and cognition in childhood chronic renal failure

Forty-five children with renal failure who were either being medically managed, receiving dialysis (hemodialysis or continuous ambulatory peritoneal dialysis) therapy or who had received successful kidney transplants were longitudinally examined on multiple neuropsychological measures. A variety of medical parameters was also obtained at each time of testing. The neuropsychological variables were correlated with the medical variables using the repeated measures regression analysis method. There were associations between levels of renal function, short-term memory and list learning. Other neuropsychological variables did not in general correlate with the medical parameters consistently for all ages at the time of initial testing. Verbal performance decreased with increasing duration of renal failure in 6- to 11-year-olds and immediate recall decreased with increasing percentile rank of systolic blood pressure in 16- to 18-year-olds.

Neurologic-developmental sequelae of chronic renal failure in infancy

Twelve children who have had chronic renal failure since infancy and underwent early dialysis (mean age 18 months) and early transplantation (mean age 28 months) were studied. Although head circumference in all was within the normal range at birth, by 1 year it was greater than 2 SD below the mean in nine, including six in whom it was greater than 3 SD below the mean. Developmentally, eight children were functioning in the subnormal range; four of these were moderately and one severely mentally retarded. It was not possible to determine whether the unfavorable neurologic-developmental outcome was the result of the toxic effects of uremia, malnutrition, or the associated psychosocial and experiential deprivation related to chronic, severe illness. Even minor insults at this vulnerable stage of brain development may produce permanent damage, and institution of therapy as early as possible may be crucial in obtaining a more favorable outcome.