Improved neurological outcome in children with chronic renal disease from infancy

Abdelaziz Elzouki, James Carroll, Dusan Butinar, Allie Moosa

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Progressive encephalopathy, developmental delay, microcephaly, electroencephalogram (EEG) and computed tomographic (CT) scan abnormalities have been reported in 80% of children with chronic renal failure (CRF) in infancy. Malnutrition, aluminium intoxication and psychosocial deprivation are proposed as causes. In 15 children with CRF from infancy we evaluated the effect of no aluminium salts and early vigorous nutritional and psychosocial support, in addition to the standard therapy, on neurological development. Six patients underwent dialysis (2 at birth) and 3 received transplants. None of our patients were given aluminium therapy. The nutritional status of the patients in the first 2 years of life was assessed with the waterlow classification. At the end of the follow-up period (mean 50 months range 14-148 months), patients underwent neurodevelopmental assessment, head CT scan, EEG, nerve conduction velocity (NCV) and auditory brain stem evoked response (ABER). None of our patients developed progressive encephalopathy or recurrent seizures. All have a normal neurological examination apart from hypotonia. Microcephaly was present in 5 patients. There was a good correlation between malnutrition in the first 2 years of life and microcephaly. Developmental delay was present in 3 patients; all 3 were microcephalic. 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 conclude that a policy of no oral aluminium therapy and early nutritional support leads to better neurological outcome in children with CRF from infancy.

Original languageEnglish (US)
Pages (from-to)205-210
Number of pages6
JournalPediatric Nephrology
Issue number2
StatePublished - Apr 1994
Externally publishedYes


  • Chronic renal failure from infancy
  • Neurological outcome
  • No aluminium therapy
  • Nutritional support

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology


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