Neurologic complications in chronic renal failure: a retrospective study

Evaluation and treatment of chronic renal failure

Chronic renal failure (CRF) is the irreversible deterioration of renal function that gradually progresses to end stage renal disease (ESRD). The chief causes of CRF include obstructive uropathy, primary glomerular diseases, reflux nephropathy and hypoplastic or dysplastic kidneys. Progressive hyperperfusion and hyperfiltration causes increasing glomerular injury and further renal damage. Symptoms of CRF are usually seen when GFR is between 10-25% of normal. Children with severe CRF often suffer from failure to thrive, growth retardation, acidosis, anemia and renal osteodystrophy. Management of CRF aims at retarding progression of renal damage and treatment of complications related to renal dysfunction. Measures suggested to retard progression include protein restriction, strict control of hypertension, use of angiotensin converting enzyme inhibitors and control of hyperlipidemia. Appropriate amounts of protein and calories are recommended to prevent growth failure. Nutritional supplements are often required. The availability of recombinant erythropoietin, calcitriol and human growth hormone has significantly improved the management of these patients. Once ESRD supervenes, renal replacement therapy in the form of chronic peritoneal or hemodialysis and transplantation is necessary.

Neuropsychological, physical, and psychosocial functioning of individuals with end-stage renal disease

Individuals (N = 24) being treated for end-stage renal disease (ESRD) were compared to healthy control participants (N = 20) on measures of neuropsychological, physical, and psychosocial functioning. ESRD patients scored significantly lower than controls (p < .03) on Trail Making Test--Part B; 37.5% of ESRD patients were classified as impaired versus 15% of controls. ESRD patients scored lower than controls on SF-36 measures of Physical Functioning (p < .001). Psychosocial deficits were on the Affect Balance Scale (p < .04) and in employment (p < .04). The hypotheses that neuropsychological status would be associated with psychosocial differences in terms of decrements in both affect and employment rates were also supported. Mediational analysis suggested that neuropsychological status plays a role in the lower employment rates seen among ESRD patients. Clinical and research implications are discussed.

Assessment of the learner: physiological readiness

Patients with end-stage renal disease (ESRD) who undergo dialytic therapy or who receive a kidney transplant are expected to learn a great deal of information about their disease and treatment. As this population encompasses a vast number of persons of varying age, education, and life skills, the ability to learn new information may be a challenge for both the patient and staff. The uremic state and its effect on cognitive function influences the patient's physiological readiness and ability to learn. Recent research, testing methods, and understanding of other effects of renal failure on cognitive function have provided more information about the patient's physiological readiness/ability to learn. Health care professionals can incorporate these new findings into their teaching programs and strategies to assure successful patient learning and outcomes.