| Theme | The Various Uremic Symptomes and their Causative Substances | |
|---|---|---|
| Title | Central nervous system | |
| Publish Date | 2005/08 | |
| Author | Eriko Kinugasa | Department of Internal Medicine, Showa University Northern Yokohama Hospital |
| Author | Hidetoshi Ito | Department of Internal Medicine, Showa University Northern Yokohama Hospital |
| Author | Sotaro Hieda | Department of Internal Medicine, Showa University Northern Yokohama Hospital |
| [ Summary ] | Many neurological complications are associated with uremic states or their treatment. Among these complications, uremic encephalopathy (UE) and dialysis encephalopathy (DE) are major diseases, with central nervous system complications. Though the precise pathophysiology of UE is unknown, the accumulation of uremic toxins, such as guanidino compounds (GC), and hormonal and metabolic imbalances are considered to be contributing factors. Concerning GCs, guanidinosuccinic acid (GSA) may contribute to epileptic and cognitive symptoms accompanying UE, via activation of excitatory NMDA receptors and concomitant inhibition of inhibitory GABA receptors. Amino acid imbalances in cerebrospinal fluid (CSF) are considered another contributing factor for UE. High CSF concentrations of glycine cause seizures and retardation, and low glutamine levels, indicate GABA deficiencies, causing dyskinesis and cognitive dysfunction. DE or dialysis dementia is a subacute, progressive and often fatal disease related to aluminium (Al) accumulation. Errors in dialysis water purification or the use of Al containing phosphate binders causes Al accumulation in many organs including the brain. DE is rare presently, but sporadic cases are reported. Cerebral atrophy (CA) is another problem during on going dialysis treatment, however, the mechanisms of CA are complex and poorly understood. |
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