Signs of autonomic neuropathy in childhood uremia

Abstract

To evaluate the presence of autonomic neuropathy in childhood uremia, cardiovascular autonomic reflexes were examined in children with chronic renal failure. Cardiovascular autonomic reflexes of 10 uremic patients on chronic dialysis and 10 transplanted patients were compared to assess the effect of transplantation on autonomic neuropathy. Resting heart rate, heart rate changes induced by deep breathing, by Valsalva maneuver, and following standing up, and blood pressure change induced by handgrip test were examined. Of the 10 uremic children, 4 showed early involvement and 2 had definite involvement of autonomic neuropathy. Only 1 of the 10 transplanted patients showed early signs of autonomic neuropathy. Autonomic tests demonstrated predominantly parasympathetic dysfunction. In conclusion, cardiovascular autonomic neuropathy is not rare in children and adolescents and young adults with chronic renal failure. In contrast, the prevalence is very low in transplanted patients with similar uremic precedents. Efforts should be made to prevent or delay this uremia-related complication.

Autonomic dysfunction in uremia assessed by heart rate variability

“…The finding that, in contrast to recent reports [13] and to our previous study [12], autonomic function of the NTX group differed significantly from the controls may be due to their mild or moderate renal insufficiency.…”

“…We demonstrated the presence of autonomic dysfunction in six of ten dialyzed uremic patients, and found its almost complete resolution following transplantation [12].…”

“…Studies in adults suggested that it can be partly improved by HD and almost completely reversed by renal transplantation [13,23]. However, until recently there were no data about uremic cardiovascular autonomic dysfunction in childhood [12].…”

“…These included 22 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)]. NTX patients were transplanted 60 months (mean, range 9-123 months) prior to the study.…”

“…Using this technique we have demonstrated the presence of autonomic dysfunction with a dominant parasympathetic involvement in dialyzed children, and its almost complete resolution following kidney transplantation [12].…”