Jabbari Bahman, Vaziri Nosratola D
Department of Neurology, Division of Movement disorders, Yale University School of Medicine, New Haven, Connecticut, USA.
Departments of Medicine, Physiology and Biophysics, Division of Nephrology and Hypertension, University of California, Irvine, USA.
Hemodial Int. 2018 Apr;22(2):150-160. doi: 10.1111/hdi.12587. Epub 2017 Aug 11.
Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.
在慢性肾脏病（CKD）患者中，身体或许没有哪个器官会像大脑那样频繁且以多种方式受到影响。导致CKD患者出现神经功能障碍的因素有多种，包括尿毒症毒素的蓄积、代谢和血流动力学紊乱、氧化应激、炎症以及血脑屏障受损等。CKD患者的神经功能障碍累及外周和中枢神经系统。CKD的外周神经症状是由躯体和颅周周围神经病变以及肌病引起的。CKD的中枢神经症状是由皮质（主要是皮质或皮质下）病变所致。认知功能下降、脑病、皮质肌阵挛、扑翼样震颤和癫痫发作是CKD皮质功能障碍的显著特征。缺血和缺氧导致的弥漫性白质病变可能是皮质下脑病的一个重要原因。CKD患者因脑水肿引起的一种特殊且较为良性的皮质下功能障碍形式被称为后部可逆性脑病。皮质下病变，尤其是当其影响基底神经节时，会引发多种运动障碍，包括帕金森综合征、舞蹈症和肌张力障碍。一种刺激敏感的反射性肌阵挛被认为起源于延髓结构。睡眠障碍和不宁腿综合征在CKD患者中很常见，且都有中枢和外周起源。本文概述了有关CKD神经并发症的性质、患病率、病理生理学、后果及治疗的现有数据。
