Non-invasive MRI reveals kidney disease, cognitive impairment correlation in pediatric patients

Children with chronic kidney disease may have an increased risk of cognitive impairment due to major blood flow changes occurring in the brain, according to research published June 12 in Radiology.  

Prior research has found chronic kidney disease affects certain age groups differently. Adults may develop hypertension and diabetes while children's brain development and cognitive function may decline. 

This differentiation in side effects prompted researchers to specifically analyze pediatric patients with early kidney disease before having experienced hypertension as adolescents and adults, explained coauthor John Detre, MD, director of the Center for Functional Neuroimaging in Radiology and vice chair for research in neurology at the Perelman School of Medicine at the University of Pennsylvania.

Detre and colleagues evaluated cerebral blood flow in the brains of 73 pediatric kidney disease patients and 57 control participants using MRI to measure cerebral blood flow in the brain.  

"Cerebral blood flow is a critically important physiological parameter that you can measure in just a few minutes with arterial spin labeling," Detre said, in a prepared statement. "This technique provides a noninvasive way of quantifying cerebral blood flow that doesn't require use of contrast agent, which is contraindicated in patients with kidney dysfunction." 

Yet to their surprise, patients with kidney disease showed higher cerebral blood flow compared with the controls, the researchers wrote, considering that decreased cognitive ability is associated with decreased blood flow in the brain.

"These findings may indicate compensatory hyperactivity, in which the brain regions are working extra hard to maintain performance," Detre explained. "Another possibility is that there's a disturbance in the regulation of blood flow in these patients."

Additionally, Detre and colleagues found a correlation between white matter cerebral blood flow and blood pressure, which could lead to white matter injury, according to the researchers. Kidney disease pediatric patients also had blood flow differences in the default mode-network of the brain compared with controls. 

"Our results confirmed that systemic effects of estimated glomerular filtration rate, hematocrit level, and blood pressure on cerebral blood flow and alterations in regional cerebral blood flow may reflect impaired brain function underlying neurocognitive symptoms in pediatric patients with chronic kidney disease," the researchers wrote.