Introduction: Children with end stage renal disease (ESRD) on regular hemodialysis (HD) are at high risk of developing many neurologic complications including both uremic neuropathy and encephalopathy. The accumulation of uremic toxins and certain electrolytes changes represent the major role for these complications and the severity of neuropathy is directly correlated with degree of these changes.
Aim of the study: is to find out the prevalence of both polyneuropathy and encephalopathy in children under regular HD and to correlate these neurologic findings with laboratory parameters.
Methods: This study included 45 children on regular HD at least for one year selected from those attending the pediatric HD units at Al Azhar university hospitals with their ages not less than 5 years. All patients were clinically evaluated together with renal functions and serum electrolytes. Both electroencephalogram (EEG) and nerve conduction velocity were done for all cases.
Results: The main etiology of ESRD was congenital anomalies of the kidney and urinary tract (40 %) followed by glomerular diseases (37.7 %) and unknown etiology (22.3 %). Nerve conduction velocity (NCV) showed abnormal findings in 22 cases (48.9) in the form of: (axonal degeneration in 19 cases and demyelination in 3 cases). On the other hand, EEG showed slowing background and epileptic discharges in 16 cases (36.6 %). There was a positive correlation between NCV findings and both potassium and phosphorus. Also, a positive correlation was shown between EEG changes and both sodium and calcium.
Conclusion: Children under regular HD can develop many neurologic abnormalities including polyneuropathy (as detected by NCV) and slowing background with epileptic discharges (as detected by EEG). Serum electrolytes changes play a basic role for these neurologic abnormalities as shown by the positive correlation between serum electrolytes and these neurologic findings.