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2010 | 10 | 1 | 42-50
Article title

Powikłania neurologiczne współistniejące z niewydolnością nerek

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EN
Neurological complications coexisting with renal failure
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Abstracts
EN
Neurological complications both due to uraemia or its management are related to the central and peripheral nervous system and muscle tissue and are the reason for increased mortality in patients with renal failure. There is the high risk of the uraemic encephalopathy, hypertensive encephalopathy, cerebrovascular diseases, and dementia in the subjects with renal failure. In the group of uraemic patients the mononeuropathies and polyneuropathies are rather common and the pathology of kidney may results in the restless legs syndrome. Despite continuous therapeutic advances many complications like uraemic encephalopathy, atherosclerosis, neuropathies and myopathy fail to fully respond to the routine treatment. Moreover, the dialytic therapy even induce new complications like dialysis dementia, intracranial haemorrhages, dialytic disequilibrium syndrome, Wernicke’s encephalopathy and osmotic myelinolysis. The use of immunosuppressive drugs in renal disease and after renal transplantation can cause opportunistic infections, the proliferative disorders within central nervous system or posterior reversible encephalopathy syndrome. In order to decrease the mortality and improve the quality of life in patients with renal failure, both nephrologists and neurologists should be familiar with neurological complications of uraemia and should collaborate. The disorders resulting in renal failure (connective tissue diseases, diabetes) may be directly related to the neurological complications.
PL
Powikłania neurologiczne w przebiegu niewydolności nerek, zarówno te spowodowane mocznicą, jak i wynikające z jej leczenia, dotyczą ośrodkowego oraz obwodowego układu nerwowego, jak również tkanki mięśniowej i stanowią przyczynę zwiększonej śmiertelności u chorych z niewydolnością nerek. Pacjenci z niewydolnością nerek są szczególnie narażeni na rozwój encefalopatii mocznicowej, encefalopatii nadciśnieniowej, chorób naczyniowych ośrodkowego układu nerwowego bądź zespołów otępiennych. W tej grupie chorych częściej niż w populacji ogólnej rozwijają się mono- i polineuropatie, a choroby nerek należą do częstszych przyczyn zespołu niespokojnych nóg. Pomimo ciągłego postępu terapeutycznego wciąż nie ma skutecznego leczenia wielu tych powikłań, m.in. encefalopatii mocznicowej, miażdżycy, neuropatii czy miopatii. Co więcej, wprowadzenie dializoterapii rozszerzyło spektrum komplikacji o otępienie dializacyjne, krwawienia śródczaszkowe, zespół nierównowagi dializacyjnej, encefalopatię Wernickego i osmotyczną mielinolizę. Leczenie immunosupresyjne stosowane zarówno w chorobach nerek, jak i u chorych po przeszczepie nerki przyczyniło się do rozwoju oportunistycznych infekcji i nowotworzenia w ośrodkowym układzie nerwowym, ponadto niekiedy powikłane jest rozwojem odwracalnej tylnej leukoencefalopatii. Znajomość tych powikłań oraz ścisła współpraca między nefrologami i neurologami mogą przyczynić się do zmniejszenia śmiertelności i poprawy jakości życia chorych z niewydolnością nerek. Należy przy tym pamiętać, że także patologie, które prowadzą do niewydolności nerek (szczególnie choroby układowe tkanki łącznej czy cukrzyca), powodują uszkodzenia ośrodkowego i obwodowego układu nerwowego, a określenie rzeczywistej przyczyny bywa niemożliwe.
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10
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1
Pages
42-50
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References
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