Abstract
Background: Patients with chronic kidney disease (CKD) on maintenance hemodialysis frequently present with neurological complications. These complications include peripheral neuropathy, encephalopathy, and stroke.Objectives: To detect the prevalence of neurological manifestations and complications in children with CKD through neurophysiological and neuro-radiological findings.Methods: The study included 50 patients with CKD admitted to a pediatric nephrology unit. Their history and complete physical and neurological examination findings had been recorded. All patients underwent nerve conduction, electromyography, electroencephalography, and magnetic resonance imaging of the brain.Results: Fifty children of both sexes (23 males and 27 females) with a mean age of (12.08 ± 3.46 year) were studied. Eleven (22%) patients with CKD developed polyneuropathy, mostly of an axonal polyneuropathy pattern, while 39 (78%) of them showed normal electrophysiological studies. No myopathy was detected. Abnormal electroencephalography findings were detected in 18% of patients, mostly generalized and focal (temporal, occipital, and frontal) epileptogenic activity. Abnormal MRI brain findings were detected in 16% of patients, mostly of encephalomalacia.Conclusion: Uremic neuropathy was highly prevalent in children with CKD on maintenance hemodialysis. They developed polyneuropathy, mostly of an axonal polyneuropathy pattern. EEG is a useful method for early recognition of subclinical uremic encephalopathy and/or epileptogenic activity. Early demonstration and management of uremic neurological conditions may decrease the physical disability of CKD patients.
Highlights
The National Kidney Foundation’s Kidney Disease and Outcome Quality Initiative (KDOQI) Group defined chronic kidney disease (CKD) as when the glomerular filtration rate (GFR) is < 60 mL/min per 1.73 m2 for ≥ 3 months or when the GFR is ≥ 60 mL/min per 1.73 m2 if other evidence of kidney damage exists, which is manifested by pathologic abnormalities reported by Uremic Neuropathy in Children With CKD
Rapid removal of urea from blood due to rapid hemodialysis resulting in osmotic gradients between the plasma and the brain that leads to cerebral edema which leads to these neurological manifestations [5]
The prevalence of peripheral neuropathy among the studied patients detected through electrophysiological study was 22% (n = 11 of 50), axonal motor and sensory neuropathy was observed in 81.8% (n = 9), and demyelinating motor neuropathy was reported in 18.2% (n = 2)
Summary
The National Kidney Foundation’s Kidney Disease and Outcome Quality Initiative (KDOQI) Group defined chronic kidney disease (CKD) as when the glomerular filtration rate (GFR) is < 60 mL/min per 1.73 m2 for ≥ 3 months or when the GFR is ≥ 60 mL/min per 1.73 m2 if other evidence of kidney damage exists, which is manifested by pathologic abnormalities reported by Uremic Neuropathy in Children With CKD renal biopsy or abnormalities detected by urine, blood tests, and imaging procedures [1]. Encephalopathy detected in patients with chronic kidney disease results from their exposure to several factors, such as uremia, hypertension, and fluid, and electrolyte disturbances [3]. If the GFR decreases below 25 mL/min with an impairment of kidney function, uremic myopathy clinical features will appear [10] as proximal muscle weakness in the muscles of the lower limbs, leading to limited function of these muscles [11]. We aimed to detect the prevalence of neurological manifestations and complications in children with chronic kidney disease through neurological examination and neurophysiological and neuro-radiological findings. Patients with chronic kidney disease (CKD) on maintenance hemodialysis frequently present with neurological complications. These complications include peripheral neuropathy, encephalopathy, and stroke
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