Neurodevelopmental follow-up of school-age children with congenital kidney disease and consecutive chronic renal failure

Aims: Dialysis and transplantation nowadays are standard therapy for renal failure in infancy. There is little information about the long-term rehabilitation regarding neurodevelopment.

Methods: 17 children (13m, 4 f) with congenital kidney disease and consecutive renal failure were examined at ages of 6.2–10.8 (mean 8.3) years. Underlying diseases were renal dysplasia (9/17), obstructive uropathy (5/17), and congenital nephrotic syndrome (3/17). Nine of the 17 children were born prematurely, 7/17 required artificial ventilation during the neonatal period, 15/17 received a kidney transplant at ages of 0.9–4.7 (mean 2.3) years. Follow-up examination included assessment of socioeconomic status (17/17), neurological and neuromotor function with tasks of the „Zürich neuromotor assessment“ (15/17), and psychometric tests including HAWIK III (16/17) and CFT (17/17).

Results: Nine of 15 children showed neuromotor dysfunction, 3/15 pathological neurological findings (1 x tremor, 1 x hemiparesis, 1 x exaggerated reflexes). HAWIK III showed reduced global IQ (74–116, mean 93, p=0.02), reduced performance IQ (68–109, mean 89, p=0.002) and normal verbal IQ (82–126, mean 98, p=0.48). In four children the global IQ was clinically significantly reduced (<85). In children with neuromotor dysfunction, performance IQ was lower than in children normal neuromotor function (mean 83 vs. 97, p=0.02), there was no difference regarding the verbal IQ (mean 96 vs. 101) and no significant difference regarding the global IQ (mean 88 vs. 98, p=0.1). These results were confirmed by the CFT.

Conclusion: At school age, children who suffered from congenital kidney disease and consecutive chronic renal failure had a reduced global IQ mainly due to a reduced performance IQ. This correlated with neuromotor dysfunction.