CIDP masquerading as uremic polyneuropathy
CIDP masquerading as uremic polyneuropathy
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CIDP 伪装成尿毒症多发性神经病
DOI：
10.1212/wnl.42.6.1248
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发表时间：
1992
期刊：
影响因子：
9.9
通讯作者：
Richard M. Green
中科院分区：
文献类型：
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作者：
Richard M. Green
尿毒症多发性神经病(UP)在临床和电诊断试验上可能与慢性炎症性脱髓鞘多神经病(CIDP)非常相似。在这里，我报告了一例对免疫抑制治疗有显著反应的尿毒症患者的多发性神经病。案件报告。26岁时，患者出现高血压和4+蛋白尿。一名内科医生诊断为“肾小球肾炎”，并开了利尿剂，但患者失去了随访。1990年2月，56岁的他因终末期肾脏疾病而出现液体超载。血尿素氮133 mg/dl，肌酐10.7 mg/dl，肌酐清除率5 Min，24小时尿蛋白2.7克，尿沉渣不活跃。肾脏超声与慢性内科肾脏疾病的诊断一致。血液透析开始了。三个月后，也就是1990年5月，他出现了膝盖以下的麻木和刺痛，随后出现了腿部和手臂的无力。他的残疾持续了3个月，最终只能坐在轮椅上。一位神经科医生将他的情况归因于UP，并建议进行肾移植。我在1991年2月对病人进行了评估。他在21岁时因为脾肿大而接受了脾切除术，并且有80年的吸烟史。药物包括速尿和布洛芬。检查显示精神状态正常，脑神经正常。除左侧小指展肌ADM(ADM)为0/5外，双侧手臂力量评分(MRC评分)为4/5；双侧小腿力量评分为2/5，仅踝背屈肌力评分为1/5。肌肉伸展反射消失。振动感严重减弱至髂骨峰，膝盖以下无针感。实验室
Uremic polyneuropathy (UP) may closely resemble chronic inflammatory demyelinating polyneuropathy (CIDP) clinically and on electrodiagnostic testing. Here I report polyneuropathy in a uremic patient that dramatically responded to immunosuppressive therapy. Case report. At age 26, the patient developed high blood pressure and 4+ proteinuria. A physician diagnosed “glomerulonephritis” and prescribed a diuretic, but the patient was lost to followup. In February 1990, a t age 56, he developed fluid overload due to end-stage renal disease. BUN was 133 mg/dl, creatinine 10.7 mg/dl, creatinine clearance 5 mumin, and 24-hour urine protein 2.7 grams; urinary sediment was inactive. Renal ultrasound was consistent with chronic medical renal disease. Hemodialysis was begun. Three months later, in May 1990, he developed numbness and tingling below the knees, followed by weakness of the legs and arms. His disability progressed over 3 months and he became confined to a wheelchair. A neurologist attributed his condition to UP and suggested renal transplantation. I evaluated the patient in February 1991. A splenectomy had been performed at age 21 because of splenomegaly, and he had an 80 pack-year history of cigarette smoking. Medications included furosemide and ibuprofen. Examination showed normal mental status and cranial nerves. Strength was graded (MRC scale) 4/5 bilaterally in the arms, except the left abductor digiti minimi (ADM) was 0/5; the legs were graded 2/5 bilaterally, except for 1/5 strength in the ankle dorsiflexors. Muscle stretch reflexes were absent. Vibration sensation was severely reduced to the iliac crests, and pin sensation was absent below the knees. Laborator