Neurological and psychometric evaluation of children with chronic renal failure

ABSTRACT

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 EEG abnormal discharge and each of blood urea and creatinine clearance level. No significant correlation could be found as well between hypertension and EEG slowing. IQ of CRF children was significantly lower than that of control children. Performance IQ scores were significantly affected by CRF more than verbal IQ. Full IQ and performance IQ scores were significantly affected by duration of CRF. There was no significant correlation between the presence of hypertension or degree of renal impairment and each of full, performance or verbal IQ scores