Kidney Week

Abstract: SA-PO459

Pediatric CKD Is Associated with Lower Cortical and Cerebellar Brain Volumes

Session Information

• Pediatric Nephrology - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Harshman, Lyndsay, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, United States

Lyndsay Harshman,

• Novak, Marci, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, United States

Marci Novak,

• Magnotta, Vincent, University of Iowa, Iowa City, Iowa, United States

Vincent Magnotta,

• Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth,

• Brophy, Patrick D., University of Rochester, Rochester, New York, United States

Patrick D. Brophy,

• Nopoulos, Peggy C., University of iowa, Iowa City, Iowa, United States

Peggy C. Nopoulos,

Background

Children with chronic kidney disease (CKD) are at risk for neurocognitive deficit. Neuroimaging studies provide the opportunity to accurately assess the brain and provide clues to the underlying mechanisms of observed neurocognitive abnormalities. To date, only a few published studies exist evaluating brain structure in pediatric CKD and often involve heterogenous samples with late CKD/end-stage populations of varying etiologies.

Methods

The purpose of this study is to quantitatively characterize brain structure in relationship to neurocognitive function in pediatric CKD patients with mild to moderate, non-glomerular CKD compared to age- and gender-matched, healthy controls using magnetic resonance imaging (MRI). Patients age 6-16 with congenital, non-glomerular causes of CKD (eGFR 30-90 ml/min/1.73m2) were invited to participate. Participants completed a neurocognitive evaluation, laboratory evaluation and MRI scan. The MRI scan included structural and functional sequences.

Results

Neurocognitive and structural MRI data were available for 26 participants (11 cases, 15 controls). Cases showed significantly lower cortical brain volume (p = 0.046) and notable volumetric decreases within the cerebellum (p= 0.016). There is specifically lower cerebellar gray matter in cases compared to controls (p =0.009). Data suggest potential for a direct relationship between structural abnormality of the cerebellum and lower eGFR (R²= 0.267, see Figure 1).

Conclusion

Our data link volumetric differences noted most prominently in the cerebellums of CKD participants with lower eGFR. It is possible that the decline in renal function associated with CKD may perpetuate these findings.Understanding the influence of pediatric CKD progression and severity on the developing brain may allow enhanced awareness of the role of disease progression on neurodevelopmental outcomes in childhood and inform new approaches to treatment and patient education across the CKD lifespan.

Funding

• NIDDK Support