Fraser C L, Arieff A I
Department of Medicine, Veteran's Affair Medical Center, San Francisco, CA.
New Horiz. 1994 Nov;2(4):518-26.
Among patients with end-stage renal disease, nervous system dysfunction remains a major cause of disability. Patients with chronic renal failure who have not yet received dialysis may develop symptoms ranging from mild sensorial clouding to delirium and coma. Dialysis itself is associated with at least three distinct disorders of the CNS: dialysis disequilibrium syndrome; dialysis dementia; and progressive intellectual dysfunction. Peripheral neuropathy is also a major cause of disability in uremic subjects. It is believed that aluminum contributes to the pathogenesis of dialysis dementia. Biochemically, brain calcium is elevated in patients with renal failure, probably because of actions of parathyroid hormone on the brain. The diagnosis of dialysis disequilibrium syndrome, intellectual dysfunction, dialysis dementia, and uremic neuropathy can be made by the characteristic clinical pictures of these syndromes and the exclusion of other causes of nervous system dysfunction.
在终末期肾病患者中，神经系统功能障碍仍然是致残的主要原因。尚未接受透析的慢性肾衰竭患者可能会出现从轻度意识模糊到谵妄和昏迷等一系列症状。透析本身至少与三种不同的中枢神经系统疾病相关：透析失衡综合征；透析性痴呆；以及进行性智力功能障碍。周围神经病变也是尿毒症患者致残的主要原因。人们认为铝在透析性痴呆的发病机制中起作用。从生化角度来看，肾衰竭患者大脑中的钙含量升高，这可能是甲状旁腺激素作用于大脑的结果。透析失衡综合征、智力功能障碍、透析性痴呆和尿毒症性神经病变的诊断可以根据这些综合征的典型临床表现并排除其他神经系统功能障碍的原因来做出。
