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Expert Rev Clin Pharmacol. 2018 Dec 2. doi: 10.1080/17512433.2019.1555468. [Epub ahead of print]

Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: Presentations, causes and treatment strategies.

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1
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.

Abstract

Uremic syndrome of chronic kidney disease (CKD) is a term used to describe clinical, metabolic and hormonal abnormalities associated with progressive kidney failure. It is a rapidly growing public health problem worldwide. Nervous system complications occur in every patient with uremic syndrome of CKD. Areas covered: This review summarized central and peripheral nervous system complications of uremic syndrome of CKD and their pathogenic mechanisms. They include cognitive deterioration, encephalopathy, seizures, asterixis, myoclonus, restless leg syndrome, central pontine myelinosis, stroke, extrapyramidal movement disorders, neuropathies and myopathy. Their pathogenic mechanisms are complex and multiple. They include (1) accumulation of uremic toxins resulting in neurotoxicity, blood brain barrier injury, neuroinflammation, oxidative stress, apoptosis, brain neurotransmitters imbalance, ischemic/microvascular changes and brain metabolism dysfunction [e.g. dopamine deficiency], (2) metabolic derangement [as acidosis, hypocalcemia, hyperphosphatemia, hypomagnesemia and hyperkalemia]; (3) secondary hyperparathyroidism, (4) erythropoietin and iron deficiency anemia, (5) thiamin, vitamin D and other nutritional deficiencies, (6) hyperhomocysteinemia, and (7) coagulation problems. Expert Commentary: Nervous system complications of uremia contribute to the patients' morbidity and mortality. Optimizing renal replacement therapy, correction of associated metabolic and medical conditions and improved understanding of possible pathogenic mechanisms of these complications is a major target for their prevention and treatment.

KEYWORDS:

Uremic syndrome; basal ganglia lesion; chorea; chronic kidney disease (CKD); myoclonus; myopathy; neuropathy; parkinsonism; stroke; uremic encephalopathy

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