Bhowmick Suvorit S, Lang Anthony E
Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital University Health Network Toronto Ontario Canada.
Mov Disord Clin Pract. 2020 Aug 10;7(7):763-779. doi: 10.1002/mdc3.13005. eCollection 2020 Oct.
Movement disorders often emerge from the interplay of complex pathophysiological processes involving the kidneys and the nervous system. Tremor, myoclonus, ataxia, chorea, and parkinsonism can occur in the context of renal dysfunction (azotemia and electrolyte abnormalities) or they can be part of complications of its management (dialysis and renal transplantation). On the other hand, myoglobinuria from rhabdomyolysis in status dystonicus and certain drugs used in the management of movement disorders can cause nephrotoxicity. Distinct from these well-recognized associations, it is important to appreciate that there are several inherited and acquired disorders in which movement abnormalities do not occur as a consequence of renal dysfunction or vice versa but are manifestations of common pathophysiological processes affecting the nervous system and the kidneys. These disorders are the emphasis of this review. Increasing awareness of these conditions among neurologists may help them to identify renal involvement earlier, take timely intervention by anticipating complications and focus on therapies targeting common mechanisms in addition to symptomatic management of movement disorders. Recognition of renal impairment in a patient with complex neurological presentation may narrow down the differentials and aid in reaching a definite diagnosis.
运动障碍通常源于涉及肾脏和神经系统的复杂病理生理过程之间的相互作用。震颤、肌阵挛、共济失调、舞蹈症和帕金森症可发生于肾功能不全（氮质血症和电解质异常）的情况下，或者它们也可能是其治疗并发症（透析和肾移植）的一部分。另一方面，肌张力障碍状态下横纹肌溶解导致的肌红蛋白尿以及运动障碍治疗中使用的某些药物可引起肾毒性。与这些已被充分认识的关联不同，重要的是要认识到，存在几种遗传性和获得性疾病，其中运动异常并非肾功能不全的结果，反之亦然，而是影响神经系统和肾脏的共同病理生理过程的表现。这些疾病是本综述的重点。神经科医生对这些情况的认识不断提高，可能有助于他们更早地识别肾脏受累情况，通过预测并发症及时进行干预，并除了对运动障碍进行对症治疗外，还专注于针对共同机制的治疗。认识到具有复杂神经系统表现的患者存在肾功能损害，可能会缩小鉴别诊断范围，并有助于做出明确诊断。
