Arterial changes in paediatric haemodialysis patients undergoing renal transplantation

Background. The relationship between primary renal diseaseand arterial wall changes in paediatric haemodialysis patientshas been little studied. The aim of the present work was todetermine the influence of primary renal disease on arterialwall pathology in uraemic paediatric patients. Methods. Twelve paediatric haemodialysis patients (sevengirls, five boys) aged 11–17 years were included in thestudy. The primary renal diseases were urinary malformationsin six patients (uropathy group) and acquired glomerular diseases(glomerulopathy group) in six patients. Age, sex distribution,duration of chronic renal failure, duration of haemodialysis,blood pressure, serum glucose, triglycerides, cholesterol, fibrinogen,calcium, phosphorus and parathyroid hormone levels were compared.Internal iliac artery samples were obtained at the time of related-donorrenal transplantation. Artery samples were fixed in formaldehydeand sections were stained separately with haematoxylin and eosin,Orcein, Verhoef–van Gieson, and Masson trichrome. Results. Five arteries had fibrous or fibroelastic intimalthickening, medial mucoid ground substance and disruption ofthe internal elastic lamella. Two of these had microcalcificationin the intimal layer; another two demonstrated atheromatousplaques; the remaining five were normal. These pathologicalchanges were found in the arteries of all six patients withuropathy, whereas of the six patients with glomerulopathy onlyone had arterial changes (P<0.001). The duration of chronicrenal failure was 4.8±1.9 years in the uropathy groupand 2.2±1.2 in the glomerulopathy group (P<0.05).The two groups were comparable in terms of serum glucose, triglycerides,cholesterol, fibrinogen, calcium, and parathyroid hormone levels,presence of hypertension, sex distribution, and duration ofhaemodialysis. Plasma phosphorus and the calciumxphosphate productwere higher in the uropathy group than in the glomerulopathygroup (P<0.05). Conclusions. This study demonstrated that pathologicalchanges are common in the arteries of uraemic paediatric patients,and that calcification and atherosclerosis are integral to thisdisease process. In our study, these alterations were more commonin the patients with uropathy. We speculate that the patientswith uropathy are more prone to these alterations due to slowerprogression and a longer duration of renal insufficiency.