Steinberg A, Efrat R, Pomeranz A, Drukker A
Int J Pediatr Nephrol. 1985 Apr-Jun;6(2):121-6.
We performed computerized tomography (CT) of the brain in 22 patients, 2 to 18 years of age, with stable chronic renal failure (n = 6), on dialysis (n = 14) and after renal transplantation (n = 2). None suffered from a systemic disease known to affect the central nervous system (CNS) and none had overt CNS dysfunction at the time of the CT examination. The most striking pathological finding was brain atrophy, which was present in 13 patients (59%). In two patients cortical infarcts were present and one patient was found to have a hypodense area in the basal ganglia. The brain atrophy could not be related to the type of basic renal disease, the age of the patient, corticosteroid dosage, the duration of the renal failure or the presence of hypertension However, the mode of treatment, i.c. hemodialysis, seemed to be a risk factor. We assume that metabolic derangements and/or the accumulation of toxic substances due to the uremic state may be responsible for the brain atrophy in young patients with CRF. Recurrent osmotic changes of the brain during hemodialysis may aggravate the process of brain atrophy.
我们对22例年龄在2至18岁的慢性肾功能衰竭患者进行了脑部计算机断层扫描（CT）检查，其中6例病情稳定，14例正在接受透析治疗，2例已接受肾移植。所有患者均无已知影响中枢神经系统（CNS）的全身性疾病，且在CT检查时均无明显的CNS功能障碍。最显著的病理发现是脑萎缩，13例患者（59%）存在脑萎缩。2例患者出现皮质梗死，1例患者基底节区发现低密度区。脑萎缩与基础肾脏疾病类型、患者年龄、皮质类固醇剂量、肾衰竭持续时间或高血压的存在无关。然而，治疗方式，即血液透析，似乎是一个危险因素。我们认为，尿毒症状态导致的代谢紊乱和/或有毒物质的积累可能是导致年轻慢性肾功能衰竭患者脑萎缩的原因。血液透析期间脑部反复的渗透变化可能会加重脑萎缩的进程。
