Single photon emission computed tomography of the brain in pediatric patients with chronic renal failure

ABSTRACT

Uremic patients have a high incidence of cerebral atrophy as a result of chronic lowering of cerebral blood flow. A decrease in brain tissue perfusion might be deleterious in combination with a very low hematocrit. The aim of our study is to study the cerebral blood flow abnormalities in patients with chronic renal failure whether on conservative management or on regular hemodialysis. Forty patients with ages ranged from 5 to 18 ys with the mean age 11 +/- 0.03 ys suffering from CRF and attending the Nephrology clinic, Abo-El-Rish Hospital are included in our study. Twenty-four patients of them were treated conservatively whereas the other 16 end-stage renal disease [ESRD] patients are on regular hemodialysis. Another 10 age and sex-matched normal children were also included as control group. All patients and controls were subjected to full medical evaluation and laboratory investigations including intact molecular assay for parathormone [PTH]. We performed Single Photon Emission Computed Tomography [SPECT] scanning of the brain for all patients and Controls. In our study we found hypoperfusion of the frontal area in our patients, compared to controls as detected by low mean values of SPECT of frontal area [p. value <0.01]. Comparing the three studied groups [conservative, dialysis, and control groups] with each other, there are no statistical significance in mean level of SPECT values of frontal area between conservative and control groups, while there is significantly decreased mean level of SPECT values of frontal area in dialysis group compared to both conservative and control groups [p. value <0.01]. So, there is evident hypoperfusion of the frontal area in dialysis group. The decreased hematocrit level in dialysis group has a significant effect on decreased level of SPECT value of the frontal area. Anemia and depression are significantly prevalent in those patients and are to be considered as predisposing factors for frontal hypoperfusion. Therefore special attention should be paid to correction of anemia and periodic assessment of cognitive development and psychosocial adaptation evaluation for ESRD children on hemodialysis