臨牀透析 Vol.29 No.10(2-3)


特集名 透析患者の中枢神経系障害
題名 透析患者の中枢神経系障害と対応 (3) 中枢性感染症と予防
発刊年月 2013年 09月
著者 下畑 誉 東京医科大学茨城医療センター腎臓内科
著者 小林 正貴 東京医科大学茨城医療センター腎臓内科
【 要旨 】 透析患者は腎機能低下に伴う免疫能の低下,および栄養状態の悪化によって感染症の罹患率が高く,重症化しやすい.中枢性感染症(細菌性髄膜炎,ウイルス性脳炎)は,バスキュラーアクセス感染や肺炎などと比べて発症頻度は低いが,罹患すると重篤化しやすく,早期診断,早期治療が非常に重要である.診断の際には,尿毒症性神経症との鑑別が問題となるが,尿毒症性神経障害は透析療法によって症状の改善を見るため鑑別可能であり,中枢性感染症が疑われた場合は,時期を逸することなく画像検査,髄液検査を施行することが必要である.
Theme Disorder of central nerve system in dialysis patients
Title Central nervous system infectious disease in dialysis patients
Author Homare Shimohata Department of Nephrology, Tokyo Medical University Ibaraki Medical Center
Author Masaki Kobayashi Department of Nephrology, Tokyo Medical University Ibaraki Medical Center
[ Summary ] Dialysis patients are prone to infectious disease because of their immunocompromised conditions and malnutrition. Although incident rates for central nervous system infectious disease, such as bacterial meningitis and viral encephalitis in dialysis patients are low compared to those related to vascular access infections or pneumonia, those conditions are often severe and even lethal. As a result, early detection and early treatment is important to save patients' lives. It is difficult to distinguish between uremic neuropathy and central nervous system infectious diseases by conducting physical examinations. However, uremic neuropathy often improves after dialysis. It is necessary to conduct imaging tests and lumbar punctures immediately if central nervous system infections are suspected.
戻る