Aphasia Associated With Acute on Chronic Kidney Failure in an Adolescent

Abstract

Acute and chronic kidney disease (CKD) have known neurological associations resulting from uremia, electrolyte disturbances, comorbidities such as hypertension, or other toxin accumulation. Reversible focal neurological deficits are relatively uncommon and poorly understood sequelae of kidney disease. Herein, we describe an unusual case of an adolescent male who developed acute aphasia during his initial presentation for acute kidney injury (AKI) superimposed on progressive CKD stage 5 associated with uremia and multiple electrolyte derangements. Symptoms resolved within one day of initiating continuous renal replacement therapy (CRRT) and gradual electrolyte and uremia correction. Such transient focal neurological deficits in AKI superimposed on progressive CKD in the pediatric population has not been widely reported.

Keywords: aphasia; aphemia; focal deficit; kidney failure; pediatric; uremia.

Figure 1. Head CT

Noncontrast head CT obtained in the emergency department reported as sinusitis without acute intracranial findings.

Figure 2. CXR

CXR demonstrating a left lower lobe opacity, which could represent pneumonia or atelectasis. A small left sided effusion was later noted.

Figure 3. Renal ultrasound

The left kidney (left) measured 7.2 cm. The right kidney (right) measured 6.5 cm, although the inferior margin was noted to be obscured by bowel gas.