“ NEUROLOGIAL CHANGES IN CKD PATIENT “
INTRODUCTION:-Patient with chronic kidney disease (CKD) are frequently
afflicted with neurological complication. These complication can potentially
affect both the central and peripheral nervous system. Common neurological
complication in CKD include stroke, cognitive dysfunction, encephalopathy
peripheral and autonomic neuropathies.these condition have significant impact
not only on patient morbidity but also on mortality risk through a variety of
mechanism. Understanding the pathophysiological mechanisms of these condition
can provide insight into effective management startegies for neurological
complication. This review describes clinical management of neurological
complication in CKDwith reference to the contributing physiological and
pathological derangement. Stroke ,cognitive dysfunction and dementia share
several pathological mechanism that may be differentiated from encephalopathy
which has similar contribute to vascular impairment and neurodegenration .
patient with autonomic neuropathy may respond to sildenafil for importance
.neurological complication often become clinically apparent at end-stage disease ,
however early detection and management of these condition in mild CKD may
reduce their impact at later stages. Chronic kidney disease (CKD) is a significant
global health concern with a prevalence of 15% in developed countries . CKD is
defined as decreased kidney function that persist for three or more month and
encompasses a continuum of disease from mild kidney damages to end –stage
disease. Disease severity is classified using a five-stage system based on the
estimated glomerular filtration rate (GFR) a calculation of waste cleared by kidney
per minute . the aetiology of CKD may be due to a primary renal disorder or as a
complication of a multisystem disorder related to comorbidities ,such as diabetes
which is now the leading cause of CKD worldwide. Irrespective of cause
,neurological complication are highly prevalent in CKD injury can occur at all level
of nervous system including central nervous system (CNS) disorders such as stroke,
cognitive dysfunction and encephalopathy , through to peripheral nervous system
.
1
, “ NEUROLOGICAL CHANGES IN CKD PATIENT”
The presence of these complication has a significant impact on patient morbidity
and mortality . such as , clinlincalmanagement of neurological complication in CKD
requires an understanding of the contributing physiological and pathological
derangements. While neurological complication often become clinically apparent
in end-stage disease ,detection and management of these condition in earlier
stages of CKD may reduce their impact at later stages. This reviews will discuss
common common neurological complication in CKD with reference to their
functional presentation, classified as either “altered mental status or physical
disability” potential cause of these functional disorder will then be discussed along
with current recomendations for clinical care .
DEFINITION:-
“The presence of markers of kidney damage for more than > 3month as defined by
structural or functional abnormalities of kidney with or without decreased
glomerular filtration rate (GFR) manifested by other pathological abnormalities or
other markers of kidney damage including abnormalities of composition of blood
or urine and or abnormalities in imaging testes “.
“The presence of GFR <60 ml/min / 1.73for >3month ,with or without other signs
of kidney damage”.
Chronic kidney disease is defined as abnormality of kidney function and structural
more than 3 month with and without implication of health.
Kidney damage for >3month as defined by structural or function abnormalities of
kidneys with or without decreased GFR , manifest by either pathological
abnormalities, b. Abnormalities in marker of kidney damage including persistently
increased protein excretion ,urine sediment examination or dipstick for red blood
cells and white blood cells or imaging studies of the kidney.
2
, “NEUROLOGICAL CHANGES IN CKD PATIENT”
Table 1 : definition of chronic kidney disease (CKD) stages according to
the K/DOQI guidelines.
GFR ml/min/1.73m2
Stages description
1.kidney damage with normal or increased GFR 90
2.kidney damage with mild reduction of GFR 60-90
3.moderate reduction of GFR 30-50
4.severe reduction of GFR 15-29
5.kidney failure <15 or dialysis
RISK FACTORS :-
• Age sex (male more affect than female)
• Diabetes mellitus
• Hypertension
• Smoking(chronic alcohol consumption)
• Family history
• Obesity (excessive weight gain)
• Epilepsy
• Multiple sclerosis
• Neuro infection
• Neurological disorders associated with malnutrition
3
, “ NEUROLOGICAL CHANGES IN CKD PATIENT”
• pain associated with neurological disorders.
• Parkinson’s disease
• Traumatic brain injuries
• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis , an inflammation of the kidney ‘s filtering units
(glomeruli).
• Interstitial nephritis , an inflammation of the kidney’s tubules and
surrounding structures.
• Polycystic kidney disease.
• Prolonged obstruction of the urinary tract , from condition such as enlarged
prostate ,kidney stones and some cancers.
• Vesicoureteral reflux , a condition that cause urine to back up into your
kidneys.
• Recurrent kidney infection ,also called pyelonephritis .
NEUROLOGICAL MANIFESTATION :-
Patient suffering from chronic kidney disease (CKD) are prone to a variety of
neurological manifestations described the various-
• Central nervous system (CNS)
• Peripheral nervous system(PNS)
• Autonomic nervous system complications
CENTRAL NERVOUS SYSTEM:
The CNS manifestatation can be attributed to two main categories
• Vascular system
• Neurodegenrative cause.
4
INTRODUCTION:-Patient with chronic kidney disease (CKD) are frequently
afflicted with neurological complication. These complication can potentially
affect both the central and peripheral nervous system. Common neurological
complication in CKD include stroke, cognitive dysfunction, encephalopathy
peripheral and autonomic neuropathies.these condition have significant impact
not only on patient morbidity but also on mortality risk through a variety of
mechanism. Understanding the pathophysiological mechanisms of these condition
can provide insight into effective management startegies for neurological
complication. This review describes clinical management of neurological
complication in CKDwith reference to the contributing physiological and
pathological derangement. Stroke ,cognitive dysfunction and dementia share
several pathological mechanism that may be differentiated from encephalopathy
which has similar contribute to vascular impairment and neurodegenration .
patient with autonomic neuropathy may respond to sildenafil for importance
.neurological complication often become clinically apparent at end-stage disease ,
however early detection and management of these condition in mild CKD may
reduce their impact at later stages. Chronic kidney disease (CKD) is a significant
global health concern with a prevalence of 15% in developed countries . CKD is
defined as decreased kidney function that persist for three or more month and
encompasses a continuum of disease from mild kidney damages to end –stage
disease. Disease severity is classified using a five-stage system based on the
estimated glomerular filtration rate (GFR) a calculation of waste cleared by kidney
per minute . the aetiology of CKD may be due to a primary renal disorder or as a
complication of a multisystem disorder related to comorbidities ,such as diabetes
which is now the leading cause of CKD worldwide. Irrespective of cause
,neurological complication are highly prevalent in CKD injury can occur at all level
of nervous system including central nervous system (CNS) disorders such as stroke,
cognitive dysfunction and encephalopathy , through to peripheral nervous system
.
1
, “ NEUROLOGICAL CHANGES IN CKD PATIENT”
The presence of these complication has a significant impact on patient morbidity
and mortality . such as , clinlincalmanagement of neurological complication in CKD
requires an understanding of the contributing physiological and pathological
derangements. While neurological complication often become clinically apparent
in end-stage disease ,detection and management of these condition in earlier
stages of CKD may reduce their impact at later stages. This reviews will discuss
common common neurological complication in CKD with reference to their
functional presentation, classified as either “altered mental status or physical
disability” potential cause of these functional disorder will then be discussed along
with current recomendations for clinical care .
DEFINITION:-
“The presence of markers of kidney damage for more than > 3month as defined by
structural or functional abnormalities of kidney with or without decreased
glomerular filtration rate (GFR) manifested by other pathological abnormalities or
other markers of kidney damage including abnormalities of composition of blood
or urine and or abnormalities in imaging testes “.
“The presence of GFR <60 ml/min / 1.73for >3month ,with or without other signs
of kidney damage”.
Chronic kidney disease is defined as abnormality of kidney function and structural
more than 3 month with and without implication of health.
Kidney damage for >3month as defined by structural or function abnormalities of
kidneys with or without decreased GFR , manifest by either pathological
abnormalities, b. Abnormalities in marker of kidney damage including persistently
increased protein excretion ,urine sediment examination or dipstick for red blood
cells and white blood cells or imaging studies of the kidney.
2
, “NEUROLOGICAL CHANGES IN CKD PATIENT”
Table 1 : definition of chronic kidney disease (CKD) stages according to
the K/DOQI guidelines.
GFR ml/min/1.73m2
Stages description
1.kidney damage with normal or increased GFR 90
2.kidney damage with mild reduction of GFR 60-90
3.moderate reduction of GFR 30-50
4.severe reduction of GFR 15-29
5.kidney failure <15 or dialysis
RISK FACTORS :-
• Age sex (male more affect than female)
• Diabetes mellitus
• Hypertension
• Smoking(chronic alcohol consumption)
• Family history
• Obesity (excessive weight gain)
• Epilepsy
• Multiple sclerosis
• Neuro infection
• Neurological disorders associated with malnutrition
3
, “ NEUROLOGICAL CHANGES IN CKD PATIENT”
• pain associated with neurological disorders.
• Parkinson’s disease
• Traumatic brain injuries
• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis , an inflammation of the kidney ‘s filtering units
(glomeruli).
• Interstitial nephritis , an inflammation of the kidney’s tubules and
surrounding structures.
• Polycystic kidney disease.
• Prolonged obstruction of the urinary tract , from condition such as enlarged
prostate ,kidney stones and some cancers.
• Vesicoureteral reflux , a condition that cause urine to back up into your
kidneys.
• Recurrent kidney infection ,also called pyelonephritis .
NEUROLOGICAL MANIFESTATION :-
Patient suffering from chronic kidney disease (CKD) are prone to a variety of
neurological manifestations described the various-
• Central nervous system (CNS)
• Peripheral nervous system(PNS)
• Autonomic nervous system complications
CENTRAL NERVOUS SYSTEM:
The CNS manifestatation can be attributed to two main categories
• Vascular system
• Neurodegenrative cause.
4
