Neurodevelopmental outcome is effectively ameliorated by kidney transplantation in children at 6 years of age: Comparison of two cases

Abstract

Chronic kidney failure and end-stage renal disease are known to have detrimental effects on neurodevelopment in pediatric patients, particularly for toddlers and young children (≤6 years old) with developing brain. We present two toddler girls diagnosed of end-stage renal disease and receiving automated peritoneal dialysis at the age of 34 months. Their initial magnetic resonance imaging of brain revealed cerebral atrophy, enlarged ventricles and infarcts in main cerebellar territories. Both of them also had seizures. One girl underwent a kidney transplant 4 years after the initiation of peritoneal dialysis. Her post-transplant neuroimaging demonstrated insignificant structural abnormalities of brain. Besides, she doesn't present notable neurological problems clinically. On the contrary, the other uremic girl has suffered from long-lasting brain atrophy, uncontrolled epilepsy and cognitive function deterioration. Learning from these two contrasting cases, it is augmented that kidney transplantation can be a favorable and effective treatment as prevention of severe neurodevelopmental disabilities in young children with end-stage renal disease. Keywords: Cerebral atrophy, End-stage renal disease, Young children, Kidney transplantation