Sakurai Takeo, Nishida Hiroshi
Department of Neurology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan.
Heliyon. 2023 Mar 3;9(3):e14255. doi: 10.1016/j.heliyon.2023.e14255. eCollection 2023 Mar.
Diabetic uremic syndrome has been rarely reported in patients on maintenance dialysis for diabetic nephropathy who present subacutely with neurological symptoms and bilateral basal ganglia lesions. There are also a few reports on metformin-induced encephalopathy, which is clinically similar to diabetic uremic syndrome. Because some patients with each of these diseases also have metabolic acidosis, it is speculated that these two diseases may have the same pathology. Recently, the term "extrapyramidal syndromes of chronic kidney disease and dialysis" (EPS-CKDD), with associated diagnostic criteria, has been proposed to describe these conditions, and metformin use is considered a risk factor for developing these syndromes. We report a case of a patient on maintenance hemodialysis for diabetic nephropathy who was taking metformin and developed subacute parkinsonism and bilateral basal ganglia lesions that rapidly improved after discontinuation of metformin with continued maintenance hemodialysis. We should ascertain whether patients with EPS-CKDD are taking metformin because it may be inappropriately prescribed for end-stage renal disease. If metformin has been prescribed, it should be discontinued immediately; its discontinuation may lead to rapid symptom recovery and improved prognosis.
糖尿病尿毒症综合征在患有糖尿病肾病且接受维持性透析的患者中很少有报道，这些患者会亚急性出现神经症状和双侧基底节病变。关于二甲双胍诱发的脑病也有一些报道，其在临床上与糖尿病尿毒症综合征相似。由于这两种疾病的一些患者也存在代谢性酸中毒，推测这两种疾病可能具有相同的病理机制。最近，有人提出了“慢性肾脏病和透析的锥体外系综合征”（EPS-CKDD）这一术语及相关诊断标准来描述这些情况，并且认为使用二甲双胍是发生这些综合征的一个危险因素。我们报告了一例患有糖尿病肾病且接受维持性血液透析的患者，该患者正在服用二甲双胍，出现了亚急性帕金森综合征和双侧基底节病变，在停用二甲双胍并继续维持性血液透析后症状迅速改善。我们应该确定患有EPS-CKDD的患者是否正在服用二甲双胍，因为它可能被不恰当地用于终末期肾病患者。如果已经开具了二甲双胍，应立即停药；停药可能会导致症状迅速恢复并改善预后。
