Movement Disorders and Renal Diseases

Abstract

Movement disorders often emerge from the interplay of complex pathophysiological processes involving the kidneys and the nervous system. Tremor, myoclonus, ataxia, chorea, and parkinsonism can occur in the context of renal dysfunction (azotemia and electrolyte abnormalities) or they can be part of complications of its management (dialysis and renal transplantation). On the other hand, myoglobinuria from rhabdomyolysis in status dystonicus and certain drugs used in the management of movement disorders can cause nephrotoxicity. Distinct from these well-recognized associations, it is important to appreciate that there are several inherited and acquired disorders in which movement abnormalities do not occur as a consequence of renal dysfunction or vice versa but are manifestations of common pathophysiological processes affecting the nervous system and the kidneys. These disorders are the emphasis of this review. Increasing awareness of these conditions among neurologists may help them to identify renal involvement earlier, take timely intervention by anticipating complications and focus on therapies targeting common mechanisms in addition to symptomatic management of movement disorders. Recognition of renal impairment in a patient with complex neurological presentation may narrow down the differentials and aid in reaching a definite diagnosis.

Uremic Striatopallidal Syndrome Manifesting as Acute Onset Chorea

“…USPS is an uncommon manifestation of kidney disease, which can present as parkinsonism or chorea, with dramatic MRI abnormalities in the basal ganglia 1 . USPS typically occurs in patients with end‐stage renal disease resulting from diabetic nephropathy 1 . In this case, the renal biopsy demonstrated membranous nephropathy, although the influence of comorbid diabetes and hypertension cannot be excluded.…”

“…USPS is an uncommon manifestation of kidney disease, which can present as parkinsonism or chorea, with dramatic MRI abnormalities in the basal ganglia 1 . USPS typically occurs in patients with end‐stage renal disease resulting from diabetic nephropathy 1 .…”

“…Renal dysfunction has been associated with a spectrum of movement disorders, including parkinsonism, tremor, myoclonus, ataxia, and chorea 1 . Here, we present a case of an African‐American man with chronic kidney disease who developed uremic striatopallidal syndrome manifesting as acute onset chorea.…”

A primary cilium in oligodendrocytes: a fine structure signal of repairs in thalamic Osmotic Demyelination Syndrome (ODS)

“…This murine investigation model would suggest that a longer time lapse into ODS repairs could be investigated to understand the clinical resolution of such regional CNS neuropathology [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]219 because similar human ODS clinical cases remained with some concerns even if for most patients the prognosis is generally favorable. 7,[220][221][222] However, a recent retrospective analysis indicated that, post hospitalization, 1 out of 6 ODS patients had died 6 months later, due to other underlying disease states.…”

“…[1][2][3][4][5][6][7][8] The ODS neuropathologic syndrome is caused by a hastily adjustment of a temporary or chronic deficiency of the homeostatic sodium gradient as it can be pertinent to diverse homeostatic hormonal sodic perturbations such as those afflicted by exaggerated body fluid losses and emergently treated for alcoholism, diabetes as well as to defective dialysis. [1][2][3][9][10][11][12][13][14] A large reference list of ODS literature was recently cited [15][16][17][18][19] and it appeared that EPM lesions can appear before any CPM ones [19][20][21][22][23][24][25] and ODS in human EPM cases would be more frequent than CPM ones. 23 There, ODS can frequently appear clinically in the elderly, hospitalized population.…”