老年慢性肾衰血透患者常见神经精神症状及相关影响因素

目的分析老年慢性肾衰血透患者常见神经精神症状及相关影响因素。方法对64例出现精神神经症状的老年慢性肾衰患者(治疗组)与无神经精神症状的慢性肾衰患者(对照组)的透析年龄、肾功能及血压水平等的关系进行比较。结果 2组患者血透失衡综合征、脑血管意外及尿毒症脑病患者的透析龄差异均有统计学意义(P0.05);治疗组尿毒症脑病患者的肾功能血肌酐水平、脑血管意外患者的血压水平均明显高于对照组(P0.05)。结论老年慢性肾衰患者出现精神神经症状与透析年龄、肾功能及血压水平等有一定关系。     

47例慢性肾功能衰竭的神经精神症状分析

作者对４７例慢性肾功能衰竭患者的神经精神症状进行了分析,现将结果报道于后。１　资　　料１－１　对象　本文对象共４７例慢性肾功能衰竭（未经透析）患者,诊断为慢性肾炎者４５例,慢性肾盂肾炎者２列。１－２　神经精神症状分析　（１）出现神经精神症状的时间多数在肾功损害１年以内１３例。（２）伴神经精神症状者的死亡率为６８－０８％（３２／４７）,其中,发生神经精神症状后１～１０天内死亡者１５例,１月以上者２例;在出现轻度神经精神症状的１５例中有４例死亡,出现重度症状（如意识障碍及痉挛等）的３２例中有２６例死…     

腹膜透析管材料特征及相关性感染

腹膜透析是急、慢性肾衰竭的主要替代疗法之一,与血液透析相比,它具有操作简单,可自行透析和最大限度保护残存肾功能的特点,目前已在国内外广泛开展。腹膜透析相关性感染是影响患者透析疗效和病死率的主要原因。资料显示,腹膜透析相关性感染与多种因素有关,包括操作方法、患者的营养状况、家居环境、文化程度及肠道因素等,而腹膜透析管材料特征所导致的感染越来越受到重视。腹膜透析管类型、临床置管操作方法的不统一以及熟练程度都会影响腹膜透析患者的治疗效果及远期预后。     

北京市兴寿社区65岁以上高血压患者并发神经症状的危险因素调查

目的总结北京市兴寿社区年龄>65岁高血压患者并发神经症状的危险因素,以指导临床治疗。方法将社区内年龄>65岁的351例高血压患者作为观察对象,对所有患者的临床资料进行分析,计算并发神经症状患者的发生率,同时分析导致患者并发神经症状的危险因素。结果所有患者中,并发神经症状者166例,发生率为47.29%。同时经单因素分析及Logistic回归分析显示高盐饮食、缺乏运动、糖尿病、吸烟、高脂血症为导致患者并发神经症状的危险因素(P<0.05)。结论北京市兴寿社区65岁以上高血压患者并发神经症状发生率较高,且多种因素均为导致并发神经症状的危险因素,临床可通过控制危险因素以降低神经症状的发生率。     

慢性肾衰竭患者抗生素应用与神经精神症状表现

目的研究慢性肾衰竭病人抗生素应用与神经精神症状的表现。方法 2011年11月~2015年11月一共有61例慢性肾衰竭并发感染病人到我院治疗,根据使用抗生素的不同将其分成了头孢组(34例)以及非头孢组(27例),比较两组病人神经精神症状的发生率以及治疗前后的简明精神病量表(BPRS)评分,并探究不同抗生素使用后病人的神经精神症状情况。结果头孢组以及非头孢组神经精神症状的总发生率分别为38.24%以及18.52%,头孢组神经精神症状的发生率显著的高于非头孢组(P0.05);抗生素使用后两组的BPRS评分明显的升高,并且头孢组的显著高于非头孢组,比较差异均具有显著性(P0.05);使用头孢拉定、头孢吡肟以及头孢哌酮三种头孢类抗生素后神经精神症状的发生率比较没有显著的差异(P0.05)。结论慢性肾衰竭感染病人在使用头孢类抗生素会大大提高精神神经症状的发生率,因此,在治疗中应结合患者情况,对抗生素的使用进行实时的调整,减少神经精神症状的发生。     

三聚氰胺致小儿肾衰竭血液透析分析及护理

对2008-04～2009-02我院36例小儿急、慢性肾衰竭进行血液透析治疗的病例分析表明,对急性肾衰竭早期透析护理效果良好,对并发症严重者效果差,对慢性肾衰竭患者可很快减轻尿毒症症状.现报告如下.     

呼吸内科疾病合并神经精神表现的护理对策

呼吸内科疾病合并神经精神症状在临床上甚为常见,最常见的原因是慢性阻塞性肺疾病合并的神经精神症状,通常称为肺性脑病,但其他原因引起的该表现亦能见到。现将我科出现神经精神症状的100例患者采取的护理对策总结如下。     

以首发精神症状的神经梅毒患者临床特征分析

目的总结以精神症状为首发神经梅毒患者的临床特点,为临床早期确诊神经梅毒提供线索。方法回顾性分析25例神经梅毒患者的精神病性症状。结果 25例患者中,误诊16例,主要误诊为双相情感障碍、精神分裂症、分裂样精神病、阿尔茨海默病、精神发育迟滞;精神病性症状共有25例,情感症状20例,认知功能改变22例,人格改变16例。结论首发精神症状的神经梅毒精神病性症状丰富,误诊率高,及时治疗能够改善精神症状。     

沟通艺术在老年维持性血液透析中的应用

随着老年人口的逐年增加,老年慢性肾衰竭接受维持性血液透析(MHD)的比例也逐年增加,由于老年人受各系统衰老和多种疾病并存的原因,加之维持性血液透析需要2～3次/周、4～5h/次的治疗模式,经济负担、身体负担、家庭矛盾等诸多因素使患者心理负担加重,依从性下降,很难做到充分透析,从而影响了患者的生存质量和生存期.     

54例SLE的神经精神障碍的临床分析

系统性红斑狼疮(SLE)伴发神经、精神障碍占25～60％;占SLE死因的第二位。本文对我院1966年5月至1984年6月间住院54例SLE伴发神经精神障碍(占同期住院SLE患者47.8％)分析如下: 资料分析 54例均按照ARA 1971年制定的“SLE伴有神经精神障碍”的诊断标准:1、有神经精神症状和体征;2.急性器质性脑病综合征;3、脑脊液异常;4、脑电图异常。四项中有一项阳性者。     

Changes in visual evoked potentials in children on chronic dialysis treatment

Visual evoked potentials (VEP) were recorded in 20 children undergoing dialysis for chronic renal failure. VEP before treatment (72 h after last dialysis) were pathological in 17 patients (85%); responses obtained 3 h after treatment were abnormal in only 6 cases (30%). Furthermore, all patients improved after treatment, except two who were unchanged. However, VEP recorded immediately after dialysis were worse in 4 of 7 patients than before treatment, probably as an effect of the dysequilibrium syndrome; they improved spontaneously afterwards. The acute changes caused by dialysis seem to be more evident in children than in adults. No correlations have been found between blood chemistry indexes and VEP modifications. Finally, VEP have proved to be more sensitive than EEG in identifying a central nervous system (CNS) dysfunction in these uremic patients.     

Neurologic complications in long-standing nephropathic cystinosis

The central nervous system has been considered to be uninvolved in nephropathic cystinosis. Survival into adulthood, following renal dialysis and transplantation, has brought attention to the sequelae of long-standing cystinosis. We examined 14 patients with cystinosis, 12 of whom had undergone renal transplantation. Two patients had neurologic symptoms. One patient had progressive bradykinesia, dementia, and spasticity with computed tomographic scan evidence of cerebral atrophy and multifocal mineralization in bilateral internal capsules and periventricular white matter. One patient had behavioral and, to a lesser extent, cognitive disturbance and computed tomographic scan evidence of marked, progressive cerebral atrophy. Although the remaining patients had normal results of neurologic examinations, 11 had roentgenographic evidence of generalized cerebral atrophy; 2 of these had abnormal electroencephalograms, 1 had borderline-deficient intellectual function, and 2 had computed tomographic scan evidence of multifocal, intracerebral mineralization. The patients with nervous system abnormalities were not distinguished by patterns of medication use, demographic or laboratory features, or the relative severity of cystinosis. Although the neurologic involvement in these patients suggests that cystinosis may eventually involve the central nervous system, the differential diagnosis must include other complications from renal failure, dialysis, and immunosuppression.     

Conduction velocity through the somesthetic pathway in chronic renal failure

The latencies of evoked potentials recorded at different levels of the peripheral and central nervous system by median nerve stimulation were measured before and after dialysis, and compared with similar recordings in normal volunteers. Abnormally slow conduction velocity was more often found in proximal rather than in distal segments of the peripheral pathway in patients with chronic renal failure. This abnormality was not correlated with the presence of clinical signs of neuropathy or low values of motor conduction velocity, neither was it affected by dialysis. These findings support the hypothesis of peripheral nerve dysfunction secondary to metabolic derangement in uraemic patients.     

An autopsy case of chronic germanium intoxication presenting peripheral neuropathy, spinal ataxia, and chronic renal failure]

We report here an autopsy case of chronic germanium intoxication with major pathological changes in the central and peripheral sensory nervous systems. The patient was a 4-year-old girl who had suffered from gait disturbance and generalized muscle weakness for 22 months. She had been given orally germanium compounds (containing germanium dioxide, 225-450 mg/day) for the previous 28 months. In addition to the findings of chronic renal failure and anemia, she presented characteristic neurological symptoms exemplified by diffuse muscle atrophy, tongue fasciculation, sensory impairment and truncal ataxia as well as areflexia. Median and ulnar sensory nerve conduction velocities were also reduced. On the 17th hospital day, she died of renal failure. In addition to conspicuous degeneration of renal tubular cells, pathological studies revealed marked nerve fiber loss, degeneration and gliosis in the dorsal column of the spinal cord, which were most conspicuous in the thoracic and cervical cord. Axonal degenerative changes were also conspicuous in the sural and sciatic nerves. High concentration of germanium was detected in the brain, cerebellum, spinal cord, sciatic nerve, liver and kidney. It was suggested that the neural involvement in the current case was caused by chronic toxicity of germanium.     

A family with DRPLA and chronic renal failure]

We reported a family with dentato-rubro-pallido-luysian atrophy (DRPLA) and chronic renal failure. The proband was a 66-year-old woman who developed gait disturbance, limb ataxia, pyramidal tract signs, and dementia since age 54. T2-weighted brain MR images revealed symmetric high-signal lesions in the cerebral white matter, in addition to cerebellar, brainstem, and cerebral cortical atrophy. She suffered from renal failure and became dialysis-dependent at the age of 59, four years after the onset of chronic nephritic syndrome. At the age of 66, she was admitted to our hospital because of hyperthermia and disturbance of consciousness, and died of DIC. Her CAG repeats in the DRPLA gene were 58 and 12. An autopsy was performed. The brain weighed 910 g. Histological findings confirmed the diagnosis of DRPLA. Her mother died of chronic renal failure. All three siblings had cerebellar ataxia, and two siblings had chronic nephritic syndrome. Among them, only her younger brother was diagnosed as non-IgA glomerulonephritis based on kidney biopsy findings at the age of 48. Though the nature of the association between DRPLA and renal dysfunction remains obscure, the DRPLA gene abnormality may be correlated with chronic renal failure in this family.     

Electroencephalogram before and after hemodialysis, peritoneal dialysis and renal transplantation: study of correlations between background activity and plasma biochemistry

We report disorganization of background activity in the EEG of 49 patients with chronic renal failure. An electroencephalographic and biochemical study was performed in 20 patients before and after dialysis sessions. We did the same study before and after peritoneal dialysis in 14 patients. We analysed the EEG compared to biochemical blood abnormalities before and after renal transplantation in 15 patients. We observed worsening of the EEG after hemodialysis and peritoneal dialysis and improvement after renal transplantation, suggesting that in our patients the abnormalities in EEG caused by chronic renal failure were reversible. From our results, we found it difficult to establish correlations between the EEG and the biochemical blood abnormalities. However, there is statistical correlation between hypernatremia, improvement of metabolic acidosis, increase of the ratio of zinc to copper and worsening of the background activity in EEG.     

Headache and hemodialysis: evaluation of the possible triggering factors and of the treatment

A growing number of patients have been undergoing dialysis procedures all around the world. Around 70% of the patients receiving dialysis treatment complain about headaches. In spite of this, headache is not well studied in this group of patients. The aims of this study are: to evaluate possible triggering factors related to hemodialysis headache and to evaluate the analgesic treatments used under this situation. We prospectively studied 50 patients with chronic renal failure attending to three dialysis services from the town of Ribeir?o Preto, State of S?o Paulo, Brazil, from January 1998 to December 1999. All of them presented headaches strictly related to the hemodialysis sessions. Headache occurred mainly in the second half of the hemodialysis (86%). Arterial hypertension (38%), arterial hypotension (12%) and changes in the weight during the hemodialysis sessions (6%) were the most consistently triggering situations. In 28% of the cases no factors were identified. Dipyrone was, by far (56%), the most frequently analgesic used. Despite being so common it noteworthy how scarce are studies in literature concerning headaches in patients with chronic renal failure. These patients, besides having to bear the burden of living with a painful and boring procedure to keep them alive, many of them have the additional burden, to live with a headache in most of the sessions. The identification of possible triggering factors and further evaluations of the treatment might increase our knowledge and contribute to reduce the burden of the headaches in patients with chronic renal failure.     

A case in the spectrum of the oculo-encephalo-hepato-renal syndrome

An 18-year-old male is presented with unprecedented central nervous system findings (cerebral dysplasia and sacral meningocele) possibly in the spectrum of the oculo-encephalo-hepato-renal syndrome. He had severe mental retardation, triplegia, epilepsy, retinitis pigmentosa, and chronic renal failure. Magnetic resonance imaging demonstrated cerebral dysplasia (left dominant abnormal gyri, hypoplastic white matter, basal ganglia, and thalamus, and absence of the septum pellucidum) and the hypoplastic cerebellum and brainstem. A sacral meningocele was observed first at 16 years of age. His renal function gradually worsened after 11 years of age. His liver function was normal. The previously reported 72 cases with the oculo-encephalo-hepato-renal syndrome are reviewed.     

Reversible visual evoked potential abnormalities in uremic children

In this case study, two cystinosis-related uremic children were followed at the Department of Nephrology, University of Montreal Hospital Center Sainte-Justine. Pattern-reversal visual evoked potentials were recorded at two time points, during dialysis treatment (time 1) and after renal transplant (time 2). Data were compared with those obtained from a control group (n = 6). The P1 component was selected and analyzed as the electrophysiologic marker of interest. At time 1, P1 latency was delayed, and P1 amplitude was reduced compared with control subjects. Both responses fell within normal range after kidney transplantation. These results indicate that renal failure and dialysis are associated with abnormal visual evoked potentials in children with chronic renal failure, but such alterations of visual processing are reversible after kidney transplant.     

Heart rate variability and cardiac arrhythmias in patients with chronic renal failure

Heart rate variability was measured from 24-h electrocardiograms in 61 patients with end stage chronic renal failure. The method used counts the number of times successive RR intervals differ by more than 50 ms over the 24-h period, and is a reliable indicator of cardiac parasympathetic activity. Also analysed were the frequency and type of ectopic beats and other arrhythmias. Twentyone subjects (34%) had varying numbers of ventricular ectopic beats, and twelve (20%) had frequent supraventricular ectopics. Total 24-h count values were abnormal in 30 (76%) of the 41 subjects whose tapes were technically suitable for this analysis. There were no sex differences, but those patients maintained on haemodialysis had significantly lower counts than those on continuous ambulatory peritoneal dialysis. We conclude that about three-quarters of patients with chronic renal failure have abnormal cardiac parasympathetic activity. This may increase susceptibility to cardiac arrhythmias and sudden death and contribute to the high mortality of patients with chronic renal failure.