Neurocognitive Functions in Pediatric Renal Transplant Patients K. Gulleroglu, E. Baskin, U.S. Bayrakci, M. Aydogan, F. Alehan, A. Kantar, F. Karakayali, G. Moray, and M. Haberal ABSTRACT Neurocognitive dysfunction is one of the major complications of chronic renal failure (CRF). Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. The aim of our study was to determine the state of neurocognitive function in pediatric renal transplant recipients. We prospectively performed a neurological examination and neuropsychological test battery (Bender-Gestalt Test, Cancellation Test, and Visual and Auditory Number Assay Test) in 20 pediatric renal transplant recipients between 6 and 16 years of age. Twenty healthy children and 20 children with CRF were included in the study as the control groups. Mean age of the renal transplant recipients was 13.50 3.40 years old. Mean evaluation time after transplantation was 2.0 0.5 years. Bender-Gestalt Test result was abnormal in 40% of patients. The results of the Cancellation Test and the Visual and Auditory Number Assay Test showed significant decline in pediatric renal transplant patients when compared with the control. We found that neurocognitive dysfunction was frequent in pediatric renal transplantation patients. Awareness of this potential problem may be helpful for early recognition and treatment. Our findings suggest that periodic neurocognitive assessments may be indicated in transplant recipients.
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EUROCOGNITIVE dysfunction is one of the major complications of chronic renal failure (CRF). High rates of cognitive impairment have been reported in many studies of patients with CRF. Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Cognitive impairment is associated with the severity of kidney disease. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. However, special physical, emotional, and behavioral needs must be addressed in these children after renal transplantation to maximize cognitive functions and academic success.1 The aim of our study was to determine the state of neurocognitive function and needs in pediatric renal transplantation patients.
PATIENTS AND METHODS We prospectively performed a neurological examination and audiometry and neuropsychological test battery (Bender-Gestalt Test,
Cancellation Test, and Visual and Auditory Number Assay Test) on 20 pediatric renal transplant recipients (9 boys and 11 girls) between 6 and 16 years of age. Twenty healthy children (10 boys and 10 girls) and 20 children with CRF (12 girls and 8 boys) were included in the study as the control groups. The immunosuppressive protocol for renal transplantation consisted of prednisolone, calcineurin inhibitor (cyclosporine A or tacrolimus), mycophenolate mofetil, and oral prednisolone. Families’ socioeconomic status was determined. School performance was recorded. All patients underwent audiological assessment by means of pure-tone audiometry (PTA). Patients were examined inside an acoustic cabin using an AC-40 Interacoustics audiometer (Assens, Denmark) to perform PTA. Prior to audiometry, otoscopy was perfomed on all patients.
From the Pediatric Nephrology Department (K.G., E.B., U.S.B., A.K.), Pediatric Neurology Department (M.A., F.A.), and General Surgery (F.K., G.M., M.H.), Baskent University, Ankara, Turkey. Address reprint requests to Esra Baskin, Prof. Dr., Department of Pediatric Nephrology, Baskent University, 6.cad.72/3, Bahcelievler/Ankara, Turkey. E-mail: [email protected]
ª 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/13/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.08.105
Transplantation Proceedings, 45, 3511e3513 (2013)
3511
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GULLEROGLU, BASKIN, BAYRAKCI ET AL
Table 1. Demographic Data of Pediatric Renal Transplantion Patients, Children With CRF, and Healthy Children Groups Transplantation Group
CRF Group
Healthy Children
Mean age (y) 13.50 3.40 12.60 3.20 14.20 2.10 Gender (F/M) 11/9 12/8 10/10 Mean dialysis 2.9 0.8 3.2 0.6 time Mean GFR 78.61 39.03 118.97 14.54 values
Table 2. The Mean Values of Visual and Auditory Number Assay Test Results in Pediatric Renal Transplantation Patients, Children With CRF and Healthy Children Groups
P
>.05 >.05 >.05
N
EUROCOGNITIVE dysfunction is one of the major complications of chronic renal failure (CRF). High rates of cognitive impairment have been reported in many studies of patients with CRF. Uremic state during CRF encompasses a wide spectrum of neurobehavioral and neurological disturbances. Cognitive impairment is associated with the severity of kidney disease. Recent studies showed that the pathophysiology of neurocognitive dysfunction in CRF is related to plasma levels of uremic solutes. Successful renal transplantation improves renal, metabolic, and endocrine functions and the quality of life. However, special physical, emotional, and behavioral needs must be addressed in these children after renal transplantation to maximize cognitive functions and academic success.1 The aim of our study was to determine the state of neurocognitive function and needs in pediatric renal transplantation patients.
PATIENTS AND METHODS We prospectively performed a neurological examination and audiometry and neuropsychological test battery (Bender-Gestalt Test,
Cancellation Test, and Visual and Auditory Number Assay Test) on 20 pediatric renal transplant recipients (9 boys and 11 girls) between 6 and 16 years of age. Twenty healthy children (10 boys and 10 girls) and 20 children with CRF (12 girls and 8 boys) were included in the study as the control groups. The immunosuppressive protocol for renal transplantation consisted of prednisolone, calcineurin inhibitor (cyclosporine A or tacrolimus), mycophenolate mofetil, and oral prednisolone. Families’ socioeconomic status was determined. School performance was recorded. All patients underwent audiological assessment by means of pure-tone audiometry (PTA). Patients were examined inside an acoustic cabin using an AC-40 Interacoustics audiometer (Assens, Denmark) to perform PTA. Prior to audiometry, otoscopy was perfomed on all patients.
From the Pediatric Nephrology Department (K.G., E.B., U.S.B., A.K.), Pediatric Neurology Department (M.A., F.A.), and General Surgery (F.K., G.M., M.H.), Baskent University, Ankara, Turkey. Address reprint requests to Esra Baskin, Prof. Dr., Department of Pediatric Nephrology, Baskent University, 6.cad.72/3, Bahcelievler/Ankara, Turkey. E-mail: [email protected]
ª 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/13/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.08.105
Transplantation Proceedings, 45, 3511e3513 (2013)
3511
3512
GULLEROGLU, BASKIN, BAYRAKCI ET AL
Table 1. Demographic Data of Pediatric Renal Transplantion Patients, Children With CRF, and Healthy Children Groups Transplantation Group
CRF Group
Healthy Children
Mean age (y) 13.50 3.40 12.60 3.20 14.20 2.10 Gender (F/M) 11/9 12/8 10/10 Mean dialysis 2.9 0.8 3.2 0.6 time Mean GFR 78.61 39.03 118.97 14.54 values
Table 2. The Mean Values of Visual and Auditory Number Assay Test Results in Pediatric Renal Transplantation Patients, Children With CRF and Healthy Children Groups
P
>.05 >.05 >.05
