Neurological complications in chronic kidney disease.
Neurological complications in chronic kidney disease.
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DOI：
10.1177/2048004016677687
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发表时间：
2016-01
影响因子：
1.6
通讯作者：
Pussell BA
中科院分区：
文献类型：
--
作者：
Arnold R;Issar T;Krishnan AV;Pussell BA
慢性肾脏病(CKD)患者常伴有神经系统并发症。这些并发症可能会同时影响中枢和外周神经系统。CKD常见的神经系统并发症包括中风、认知功能障碍、脑病、周围神经和自主神经病变。这些情况不仅对患者的发病率有重大影响，而且还通过各种机制对死亡风险产生重大影响。了解这些疾病的病理生理机制可以为神经并发症的有效治疗策略提供洞察力。本文综述了慢性肾脏病神经系统并发症的临床处理，并对其生理和病理障碍进行了分析。中风、认知功能障碍和痴呆症有几种共同的病理机制，可能导致血管损伤和神经退行性变。认知功能障碍和痴呆症可与脑病相鉴别，后者有相似的致病因素，但表现为急性和快速进行性，并可伴有震颤和星形畸形。最近的证据表明，限制饮食中的钾可能是一种有效的周围神经病变的预防措施。痛性神经性症状的治疗可以通过药物手段来实现，并考虑到降低肾功能的剂量和副作用。自主神经病变的患者可能会对西地那非治疗阳萎有反应。神经系统并发症通常在终末期疾病时临床表现明显，然而，在轻度CKD中及早发现和处理这些情况可能会减少它们在后期的影响。
Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.