Peer-reviewed article
Beyond Kidney Function: A Neuro-Renal Perspective on Personalized Care in Pediatric Chronic Kidney Disease.
Manzar A, Tonkovic U, Mijuskovic S, Sic A, Altic A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines how chronic kidney disease in children affects brain development and learning, not just kidney function. The paper proposes that CKD disrupts neurodevelopment through biological, vascular, inflammatory, and psychosocial pathways, leading to cognitive impairment and educational difficulties. Even when kidney transplants restore kidney function, children's brain development may not fully recover. The authors argue that pediatric nephrology should include routine neurodevelopmental assessment as part of comprehensive care.
Key points
- CKD in children disrupts brain development through multiple interconnected mechanisms beyond renal dysfunction
- Children with CKD show neurocognitive impairment, structural brain abnormalities, and adverse educational outcomes
- Kidney transplantation restores renal function but does not necessarily restore normal neurodevelopmental trajectories
- Psychosocial burden contributes to the broader health consequences of pediatric CKD
- Integrating routine neurodevelopmental assessment into pediatric nephrology care is recommended
Limitations
This is a perspective paper that synthesizes existing evidence rather than presenting original research data. It does not provide specific prevalence rates, effect sizes, or detailed comparative evidence on interventions, limiting its utility for quantifying the magnitude of neurodevelopmental impact or evaluating treatment effectiveness.
Abstract
Pediatric chronic kidney disease (CKD) is traditionally viewed as a disorder of impaired renal function, yet its effects extend far beyond the kidneys. Growing evidence indicates that CKD may disrupt brain development through interconnected biological, vascular, inflammatory, and psychosocial mechanisms, with lasting consequences for cognition, mental health, and educational attainment. In this perspective, we propose the kidney-brain axis as a neuro-renal framework for understanding these neurological consequences of pediatric CKD. We discuss current evidence linking CKD with neurocognitive impairment, structural brain abnormalities, psychosocial burden, and adverse educational outcomes, while examining the biological mechanisms that may underlie these associations. We also consider the role of kidney transplantation, emphasizing that restoration of renal function does not necessarily restore normal neurodevelopmental trajectories. Finally, we outline the clinical implications of integrating routine neurodevelopmental assessment into pediatric nephrology care and highlight priorities for future research. Recognizing neurodevelopment as a core component of pediatric CKD may help redefine disease burden and support more comprehensive, lifelong care for affected children.