Abstract
A literature review was conducted to summarize current understanding of the effects of severe chronic renal failure (CRF), when present from infancy, on neurologic development. Data were obtained from the results of 95 examinations performed in 85 patients, most of whom had been studied after 12 months of age, or following initiation of maintenance dialysis or successful transplantation. CRF was diagnosed at birth or during the neonatal period in 71.7% of these patients; serum creatinine concentrations or calculated clearances were ≥2.0 mg/dl (177 μmol/l) or <15 ml/min per 1.73 m2, respectively, in 75.8%. Head circumferences were >2 standard deviations below the mean for age in 33 of 51 (64.7%) patients. Developmental delay was identified in 63.2% of all cases, and in 29 of 48 (60.4%), 16 of 19 (84.2%), and 4 of 13 (30.7%) patients studied while receiving conservative management or maintenance dialysis, or following successful transplantation, respectively. Moderate to severe delays were commoner for gross motor and language development. No significant relationships could be identified between age or severity of CRF at diagnosis and either the prevalence or severity of developmental delay. Other factors that may have contributed to observed developmental delays are also discussed, including aluminum loading, hyperparathyroidism, undernutrition, and psychosocial problems. New data are presented and discussed, and recommendations for future studies provided.
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Rotundo A, Nevins TE, Lipton M, Lockman LA, Mauer SM, Michael AF (1982) Progressive encephalopathy in children with chronic renal insufficiency in infancy. Kidney Int 21: 486–491
Crittenden MR, Holliday MA, Piel CF, Potter DE (1985) Intellectual development of children with renal insufficiency and end stage disease. Int J Pediatr Nephrol 6: 275–280
Kleinknecht C, Broyer M, Huot D, Marti-Henneberg C, Dartois A-M (1983) Growth and development of nondialyzed children with chronic renal failure. Kidney Int 24 [Suppl 15]: S40–S47.
McGraw ME, Haka-Ikse K (1985) Neurologic-developmental sequelae of chronic renal failure in infancy. J Pediatr 106: 579–583
Bird AK, Semmler CJ (1986) The early developmental and neurologic sequelae of children with kidney failure treated by CAPD/CCPD. Pediatr Res 20: 446A
So SKS, Chang PN, Mauer SM, Simmons RL, Najarian JS, Nevins TE (1985) The effects of renal transplantation in infancy on psychomotor development. (Abstract) Kidney Int 27: 348
Kohaut EC, Whelchel JR, Waldo FB, Diethelm AG (1985) Living-related donor renal transplantation in children presenting with end-stage renal disease in the first month of life. Transplantation 40: 725–726
Bale JF Jr, Siegler RL, Bray PF (1980) Encephalopathy in young children with moderate chronic renal failure. Am J Dis Child 134: 581–583
Baluarte HJ, Gruskin AB, Hiner LB, Foley CM, Grovey WD (1977) Encephalopathy in children with chronic renal failure. Proc Dial Transplant Forum 7: 95–97
Sedman AB, Miller NL, Warady BA, Lum GM, Alfrey AC (1984) Aluminum loading in children with chronic renal failure. Kidney Int 26: 201–204
Geary DF, Fennell RS, Andriola M, Gudat J, Rodgers BM, Richard GA (1980) Encephalopathy in children with chronic renal failure. J Pediatr 96: 41–44
Griswold WR, Reznik V, Mendoza SA, Trauner D, Alfrey AC (1983) Accumulation of aluminum in a nondialyzed uremic child receiving aluminum hydroxide. Pediatrics 71: 56–58
Sedman AB, Wilkening GN, Warady BN, Lum GM, Alfrey AC (1984) Encephalopathy in childhood secondary to aluminum toxicity. J Pediatr 105: 836–838
Salusky IB, Coburn JW, Paunier L, Sherrard DJ, Fine RN (1984) Role of aluminum hydroxide in raising serum aluminum levels in children undergoing continuous ambulatory peritoneal dialysis. J Pediatr 105: 717–720
Fennell RS III, Rasbury WC (1980) Cognitive functioning of identical twins discordant for prune belly syndrome and end stage renal failure. Int J Pediatr Nephrol 1: 234–239
Dobbing J (1968) Effects of experimental undernutrition on development of the nervous system. In: Scrimshaw NS, Gordon JE (eds) Malnutrition, learning and behavior. MIT Press, Cambridge, Mass, pp 181–202
Winick M (1969) Malnutrition and brain development. J Pediatr 74: 667–679
Stoch MB, Smythe PM, Moodie AD, Bradshaw D (1982) Psychosocial outcome and CT findings after gross undernourishment during infancy: a 20-year developmental study. Dev Med Child Neurol 24: 419–436
Evans D, Bowie MD, Hansen JDL, Moodie AD, van der Spuy HIJ (1980) Intellectual development and nutrition. J Pediatr 97: 358–363
Dobbing J, Sands J (1970) Timing of neuroblast multiplication in developing human brain. Nature 226: 639–640
Hermann HW (1969) The relationship of neonatal nutrition to brain growth. Minn Med 52: 867–870
Dobbing J, Sands J (1973) The quantitative growth and development of the human brain. Arch Dis Child 48: 757–767
Winick M, Rosso P (1969) The effect of severe early malnutrition on cellular growth of human brain. Pediatr Res 3: 181–184
Martinez M (1982) Myelin lipids in the developing cerebrum, cerebellum, and brain stem of normal and undernourished children. J Neurochem 39: 1684–1692
Winick M, Rosso P (1969) Head circumference and cellular growth of the brain in normal and marasmic children. J Pediatr 74: 774–778
Pryor H (1968) Abnormally small head size and intellect in children. J Pediatr 73: 593–598
Platts MM, Anastassiades E (1981) Dialysis encephalopathy: precipitating factors and improvement in prognosis. Clin Nephrol 15: 223–228
Rosso P, Hormazabal J, Winick M (1970) Changes in brain weight, cholesterol, phospholipid, and DNA content in marasmic children. Am J Clin Nutr 23: 1275–1279
Chase HP, Canosa CA, Dabiere CS, Welch NN, O'brien D (1974) Postnatal undernutrition and human brain development. J Ment Defic Res 18: 355–367
Waterlow JC (1976) Classification and definition of protein-energy malnutrition. In: Beaton GH, Bergen JM (eds) Nutrition in preventive medicine. World Health Organization. Geneva, pp 530–555
Holliday MA (1972) Calorie deficiency in children with uremia: effect upon growth. Pediatrics 50: 590–597
Nathan E, Pedersen SE (1980) Dialysis encephalopathy in a non-dialyzed uraemic boy treated with aluminum hydroxide orally. Acta Paediatr Scand 69: 793–796
Randall ME (1983) Aluminum toxicity in an infant not on dialysis. Lancet 1: 1327–1328
Andreoli SP, Bergstein JM, Sherrard DJ (1984) Aluminum intoxication from aluminum-containing phosphate binders in children with azotemia not undergoing dialysis. N Engl J Med 310: 1079–1084
Cogan MG, Covey CM, Arieff AI, Wisniewski A, Clark OH, Lazarowitz V, Leach W (1978) Central nervous system manifestations of hyperparathyroidism. Am J Med 65: 963–970
Cooper JD, Lazarowitz VC, Arieff AI (1978) Neurodiagnostic abnormalities in patients with acute renal failure. J Clin Invest 61: 1448–1455
Guisado R, Arieff AI, Massry SG, Lazarowitz V, Kerian A (1975) Changes in the electroencephalogram in acute uremia. J Clin Invest 55: 738–745
Polinsky MS (1984) Neurologic complications of end stage renal disease, dialysis, and transplantation. In: Fine RN, Gruskin AB (eds) ERSD in children. WB Saunders, Philadelphia, p 309
Perrin EC, Gerrity PS (1984) Development of children with a chronic illness. Pediatr Clin North Am 31: 19–31
Fielding D, Moore B, Dewey M, Ashley P, McKendrick T, Pinkerton P (1985) Children with end-stage renal failure: psychological effects on patients, siblings and parents. J Psychosom Res 29: 457–465
Korsch BM, Negrete VF, Gardner JE, Weinstock CL, Mercer AS, Grushkin CM, Fine RN (1973) Kidney transplantation in children: psychosocial follow-up study on child and family. J Pediatr 83: 399–408
Hollingshead AB, Redlich FC (1958) The index of social position. In: Hollingshead AB, Redlich FC (eds) Social class and mental illness. Wiley, New York, pp 387–397
Montgomery RD (1962) Changes in the basal metabolic rate of the malnourished infant and their relation to body composition. J Clin Invest. 41: 1653–1663
Wyngaarden JB (1986) Corticosteroid treatment follow-up: JAMA 255: 1105
Fitzhardinge PM, Eisen A, Lejtenyi C, Metrakos K, Ramsay M (1974) Sequelae of early steroid administration to the newborn infant. Pediatrics 53: 877–883
Weichsel ME Jr (1977) The therapeutic use of glucocorticoid hormones in the perinatal period: potential neurologic hazards. Ann Neurol 2: 364–366
Arbus GS, Hardy BE, Balfe JW, Churchill BM, Steele BT, Baumal R, Curtis RN (1983) Cadaveric renal transplants in children under 6 years of age. Kidney Int 24 [Suppl 15]: S111-S115
Schlieper A (1985) Chronic illness and school achievement. Dev Med Child Neurol 27: 69–79
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Polinsky, M.S., Kaiser, B.A., Stover, J.B. et al. Neurologic development of children with severe chronic renal failure from infancy. Pediatr Nephrol 1, 157–165 (1987). https://doi.org/10.1007/BF00849288
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DOI: https://doi.org/10.1007/BF00849288