RESUMO
Various neurological and psychological disturbances in children with chronic renal failure [CRF] were reported, the quality of life and psychological adaptation of these children became of increasing interest as the prognosis of this condition improves and mortality decreases. It is recognized, however, that medical advances in nutritional support, pharmacotherapy and dialysis techniques will only finally pay off if the patient adapts to the chronic disease and if the optimal rehabilitation is achieved. The aim of the present work is to evaluate children with CRF on regular hemodialysis [HD] as regards neurological and psychological abnormalities and the correlation with the clinical, as well as, biochemical changes present in these children. The study included 25 children with CRF on regular HD as well as 25 apparently healthy children of matching age and sex as controls. All cases and control children had full clinical assessment Laboratory investigations included complete blood count, complete urine analysis, urine culture, blood urea, and serum creatinine [S.Cr] and serum electrolytes. Creatinine clearance was calculated according to Schwartz formula. Electroencephalogram [EEG] was also done. intelligences quotient [IQ] was estimated. The results showed that the incidence of convulsions and alteration of consciousness Were found significantly higher when duration of CRF is > one year or associated with hypertension, blood urea is > 25 mmol/L, and creatinine clearance is [10 ml/min/1.73 m2. Headache and irritability were significantly higher when CRF is associated with hypertension. Depression was significantly higher when duration of CRF is > one year, blood urea is > 25mmol/L. EEG abnormalities in CRF children included slow background rhythm [52%], abnormal discharge [44%] and bilateral spike and wave complex [20%]. Slow background rhythms was significantly higher when duration of CRF is > one year, blood urea is > 25 mmol/L, and creatinine clearance is
Conclusion: the risk factors for neurological complications in children with CRF are multifactorial and complex. When duration of CRF is > one year, blood urea is > 25 mmol/L, creatinine clearance is < than 10 ml/min/1.73 m2 or hypertension is developed, the frequency of encephalopathy and convulsions is higher. The presence of slow background rhythm in EEG records gives attention to duration of CRF and biochemical disturbances. Psychiatric disturbances and intellectual impairment should be considered as a part of the pediatric handling of children with CRF and need an expertise to be available in the pediatric nephrology team for dealing with both problems. IQ test is recommended to be done regularly as intellectual impairment shows significant correlation with duration of CRF