Kambampati Srikala, Wasim Shehnaz, Kukkar Vishal, Awad Vanessa M, Malik Bilal Haider
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2020 Aug 23;12(8):e9965. doi: 10.7759/cureus.9965.
Restless Leg Syndrome (RLS), or Willis-Ekbom disease (WED), is an irresistible urge to move the legs, predominantly while resting, sitting, or sleeping, which disrupts sleep and impairs quality of life. RLS can occur secondary to uremia in chronic kidney disease (CKD) patients due to inadequate hemodialysis. Early diagnosis is essential to prevent muscular atrophy and to improve the quality of life of RLS patients, especially those with end-stage renal disease (ESRD). Cardiac mortality high in uremic RLS patients due to associated discomfort and lowering the duration of hemodialysis treatment. This review focuses on and discusses the diagnosis, treatment, and associated comorbid conditions of uremic RLS. Though the exact pathophysiology is unknown, altered transferrin expression in the choroid plexus, increased glutamate levels in the thalamus, decreased opioid receptors, dopamine system dysfunction, calcium/phosphate imbalance, and single nucleotide polymorphisms in the BTBD9 and MEIS1 genes are a few nonconfirmatory pathophysiological concepts for uremic RLS. Nonpharmacological options include lowering the temperature of dialysate by 1 degree C and home-based therapies like massages, warm/cold baths, and aerobic exercises. Pharmacological therapy like dopamine agonists ropinirole and pramipexole reduces the symptoms effectively. However, surgical options like parathyroidectomy and renal transplantation are stated as the best treatment options in patients suffering from uremic RLS.
不宁腿综合征(RLS),即威利斯-埃克博姆病(WED),是一种难以抑制的腿部活动冲动,主要在休息、坐着或睡觉时出现,会扰乱睡眠并损害生活质量。由于血液透析不充分,慢性肾脏病(CKD)患者的尿毒症可继发RLS。早期诊断对于预防肌肉萎缩和提高RLS患者尤其是终末期肾病(ESRD)患者的生活质量至关重要。尿毒症RLS患者的心脏死亡率较高,原因是相关不适以及血液透析治疗时间缩短。本综述重点关注并讨论尿毒症RLS的诊断、治疗及相关合并症。尽管确切的病理生理学尚不清楚,但脉络丛中转铁蛋白表达改变、丘脑中谷氨酸水平升高、阿片受体减少、多巴胺系统功能障碍、钙/磷失衡以及BTBD9和MEIS1基因中的单核苷酸多态性是尿毒症RLS的一些未经证实的病理生理概念。非药物治疗选择包括将透析液温度降低1摄氏度以及家庭疗法,如按摩、温水/冷水浴和有氧运动。像罗匹尼罗和普拉克索这样的多巴胺激动剂等药物治疗可有效减轻症状。然而,甲状旁腺切除术和肾移植等手术选择被认为是尿毒症RLS患者的最佳治疗方案。