Cerebral Palsy and Education

Kidney disease and cerebral palsy are more deeply connected than doctors had previously realized. In fact, the latest research has led to kidney disease being considered one of the most common disorders associated with cerebral palsy

In addition to that, a recent study by Michigan Medicine revealed that advanced kidney diseases can be potentially life-threatening for cerebral palsy patients, independent of other factors, such as cardiovascular conditions and cancer. 

How is Kidney Disease Associated with Cerebral Palsy?

Cerebral Palsy is a neurodevelopment condition that can lead to urological dysfunction and decreased physical activity. These can become risk factors for kidney disease. As the child enters adulthood, this adverse relationship between the two conditions continues to grow. Adults with cerebral palsy often suffer from high blood pressure, which is another risk factor for kidney disease and other kidney problems. 

As per the results of the Michigan Medicine study, the researchers suspected that physicians miss early signs that indicate kidney disease while examining cerebral palsy patients. However, with the information available now, early interventions may make it possible to prevent the condition from getting worse.

According to the assistant professor of physical medicine and rehabilitation at Michigan Medicine and lead author of the paper, Daniel Whitney, the issue could also rise from overestimating kidney functions. He said that the existing clinical methods to assess kidney function end up being influenced by muscle mass. This provides an inaccurate picture regarding kidney health for patients that have cerebral palsy. 

Interpretation Errors

When blood is drawn for kidney function tests, physicians zero in on a waste product of the muscles known as creatinine. An equation determines how well the bloodstream is being filtered by the kidneys by examining the creatinine levels. If the creatinine levels are high, it means the kidney is not functioning well. 

Whitney further elaborated that cerebral palsy patients have low muscle mass. Therefore, they generally have lower creatinine levels as well. As a result, when the kidney function is examined, the value actually reflects the low muscle mass instead of the kidney function. Therefore, the physicians may interpret the kidney function as being better than it is in reality. 

“It’s not an error in the test so much as an error in the interpretation of it,” Whitney added. “Future work will need to identify a better way to capture kidney function given the issues with these clinical tests for people with cerebral palsy.” 

In addition to the estimated glomerular rate (eGFR) from creatinine being commonly used to understand kidney function, it is also used to determine the stages of kidney function and when the patient should be recommended to get a nephrology evaluation. 

Andrea Oliverio, the co-author of the paper as well as assistant professor of nephrology at Michigan Medicine, noted that it is likely for patients to not be recommended for nephrology evaluation in time if the current methods are overestimating kidney functions of an entire population. 

She further added that physicians made use of these equations to determine dosage for medications. As a result, patients might end up getting higher doses if their kidney function has been overestimated.  

The data of more than 16,700 adults with cerebral palsy was analyzed by the research team. An estimated 7.3% of these patients had kidney disease. After taking about two dozen co-morbidities into account, they found that kidney disease was directly linked with higher mortality, especially during the end stages. 

Possible Solutions

Another side effect of poor kidney health is that it increases the risk of developing cardiovascular disease, which is one of the leading causes of death in cerebral palsy patients. Whitney argues that kidney disease could be a major cause behind this well-known issue of cardiovascular disease among people with cerebral palsy, as the condition itself is often overlooked. 

As per Whitney, we consider kidney disease as a benign, passive condition but this is untrue. It is a real problem and often gets overlooked. He said that poor kidney function usually isn’t evident in terms of symptoms like experiencing pain in your kidneys when they aren’t working properly. We need to be able to detect and manage declining kidney function early on so that it cannot cause other medical issues. 

Whitney further claimed that he and his research team are in the process of finding more accurate methods of measuring kidney function to aid people with cerebral palsy. According to Oliverio, if kidney disease is caught early on, it gives the physician adequate time to recommend the patients the necessary lifestyle changes and medications to slow down the progression of the disease. 

Whitney further added, “We don’t necessarily need to re-invent the wheel when it comes to using standard clinical tests to measure organ health. But, for people with cerebral palsy and other disabilities, we need to figure out how to better utilize these tests and their values to capture the individual’s true organ health and function.” 

Conclusion 

While it may take time to develop proper methods to examine kidney function, the good news is that the process has already begun. Physicians and healthcare providers are actively looking for ways to improve the treatment for cerebral palsy patients. The recent finding of the link between cerebral palsy and kidney disease has led to this area of research becoming a priority for a number of physicians. 

Therefore, we can hope that there will be a positive development in the near future, which will help decrease the mortality rate among people with cerebral palsy. 

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