IMPROVED NEUROLOGICAL OUTCOME IN CHILDREN WITH CHRONIC RENAL-DISEASE FROM INFANCY

Progressive encephalopathy, developmental delay, microcephaly, electro encephalogram (EEG) and computed tomographic (CT) scan abnormalities h ave been reported in 80% of children with chronic renal failure (CRF) in infancy. Malnutrition, aluminium intoxication and psychosocial depr ivation are proposed as causes. In 15 children with CRF from infancy w e evaluated the effect of no aluminium salts and early vigorous nutrit ional and psychosocial support, in addition to the standard therapy, o n neurological development. Six patients underwent dialysis (2 at birt h) and 3 received transplants. None of our patients were given alumini um therapy. The nutritional status of the patients in the first 2 year s of life was assessed with the waterlow classification. At the end of the follow-up period (mean 50 months range 14-148 months), patients u nderwent neurodevelopmental assessment, head CT scan, EEG, nerve condu ction velocity (NCV) and auditory brain stem evoked response (ABER). N one of our patients developed progressive encephalopathy or recurrent seizures. All have a normal neurological examination apart from hypoto nia. Microcephaly was present in 5 patients. There was a good correlat ion between malnutrition in the first 2 years of life and microcephaly . Developmental delay was present in 3 patients; all 3 were microcepha lic. There was evidence of brain atrophy on CT scan in only 3 patients . EEG was abnormal in 6 patients, but only severe in 1 patient. Only 1 patient had diminished NCV; all patients had a normal ABER. We conclu de that a policy of no oral aluminium therapy and early nutritional su pport leads to better neurological outcome in children with CRF from i nfancy.