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2016 ; 5
(ä): 2048004016677687
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Neurological complications in chronic kidney disease
#MMPMID27867500
Arnold R
; Issar T
; Krishnan AV
; Pussell BA
JRSM Cardiovasc Dis
2016[Jan]; 5
(ä): 2048004016677687
PMID27867500
show ga
Patients with chronic kidney disease (CKD) are frequently afflicted with
neurological complications. These complications can potentially affect both the
central and peripheral nervous systems. Common neurological complications in CKD
include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic
neuropathies. These conditions have significant impact not only on patient
morbidity but also on mortality risk through a variety of mechanisms.
Understanding the pathophysiological mechanisms of these conditions can provide
insights into effective management strategies for neurological complications.
This review describes clinical management of neurological complications in CKD
with reference to the contributing physiological and pathological derangements.
Stroke, cognitive dysfunction and dementia share several pathological mechanisms
that may contribute to vascular impairment and neurodegeneration. Cognitive
dysfunction and dementia may be differentiated from encephalopathy which has
similar contributing factors but presents in an acute and rapidly progressive
manner and may be accompanied by tremor and asterixis. Recent evidence suggests
that dietary potassium restriction may be a useful preventative measure for
peripheral neuropathy. Management of painful neuropathic symptoms can be achieved
by pharmacological means with careful dosing and side effect considerations for
reduced renal function. Patients with autonomic neuropathy may respond to
sildenafil for impotence. Neurological complications often become clinically
apparent at end-stage disease, however early detection and management of these
conditions in mild CKD may reduce their impact at later stages.