Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.
Kidney Int. 2022 Feb;101(2):227-241. doi: 10.1016/j.kint.2021.09.025. Epub 2021 Nov 1.
Uremic encephalopathy encompasses a wide range of central nervous system abnormalities associated with poor kidney function occurring with either progressive chronic kidney disease or acute kidney injury. The syndrome is likely caused by retention of uremic solutes, alterations in hormonal metabolism, changes in electrolyte and acid-base homeostasis, as well as changes in vascular reactivity, blood-brain barrier transport, and inflammation. There are no defining clinical, laboratory, or imaging findings, and the diagnosis is often made retrospectively when symptoms improve after dialysis or transplantation. The diagnosis is also made difficult because of the many confounding and overlapping conditions seen in patients with chronic kidney disease and acute kidney injury. Thus, institution of kidney replacement therapy should be considered as a trial to improve symptoms in the right clinical context. Neurological symptoms that do not improve after improvement in clearance should prompt a search for other explanations. Further knowledge linking possible uremic retention solutes with neurological symptoms is needed to better understand this syndrome as well as to develop more tailored treatments that aim to improve cognitive function.
尿毒症脑病涵盖了一系列与肾功能不佳相关的中枢神经系统异常，这些异常与慢性肾脏病的进行性进展或急性肾损伤有关。该综合征可能是由尿毒症溶质的潴留、激素代谢的改变、电解质和酸碱平衡的变化，以及血管反应性、血脑屏障转运和炎症的改变引起的。该综合征没有明确的临床、实验室或影像学发现，通常在透析或移植后症状改善时回顾性诊断。由于慢性肾脏病和急性肾损伤患者中存在许多混杂和重叠的情况，因此诊断也很困难。因此，应在适当的临床环境下，将肾脏替代治疗作为改善症状的一种尝试。如果清除率改善后神经症状仍未改善，则应寻找其他原因。需要进一步了解可能与尿毒症潴留溶质相关的神经症状，以便更好地理解该综合征，并制定更有针对性的治疗方法，以改善认知功能。
