Uraemic Myopathy: Fact or Fiction

Fahal, I. H.; Bell, G. M.

doi:10.1177/039139889802100401

“…Patients with myopathy are substantially limited in function due to reduced endurance and capacity for exercise, leading to an increase in mortality and morbidity. 44 …”

Section: Physical Disabilitymentioning

confidence: 99%

Neurological complications in chronic kidney disease

Arnold

¹

,

Issar

²

,

Krishnan

³

et al. 2016

JRSM Cardiovascular Disease

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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“…Patients with myopathy are substantially limited in function due to reduced endurance and capacity for exercise, leading to an increase in mortality and morbidity. 44 Pathophysiology. The pathophysiology of uraemic myopathy is unclear as there is an interplay of various mechanisms such as oxidative stress.…”

Section: Myopathymentioning

confidence: 99%

“…28 Atrophy of skeletal muscle via metabolic acidosis in uraemia is likely due to protein metabolism abnormalities and evidence suggests increase of adequate amino acid intake does not seem to improve these abnormalities. 44 The prevalence of uraemic myopathy is higher in patients with diabetic CKD, suggesting that insulin resistance plays a role in the development of myopathy. 44 This is probably due to the decrease of glucose as an energy source and insulin resistance also associated with protein catabolism.…”

Section: Myopathymentioning

confidence: 99%

“…44 The prevalence of uraemic myopathy is higher in patients with diabetic CKD, suggesting that insulin resistance plays a role in the development of myopathy. 44 This is probably due to the decrease of glucose as an energy source and insulin resistance also associated with protein catabolism.…”

Section: Myopathymentioning

confidence: 99%

“…44 However, demonstration of weakness in proximal pelvic muscles is a strong indicator of myopathy. Muscle biopsy studies have shown atrophy of type II fibres and fibre splitting, 44,45 but biopsy is rarely undertaken due to the invasive nature of the procedure. No specific treatment exists for uraemic myopathy however management of the potential contributing factors such as hyperparathyroidism, vitamin D and anaemia may be beneficial.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

See 2 more Smart Citations

Neurological complications of chronic kidney disease

Krishnan

¹

,

Kiernan

²

2009

View full text Add to dashboard Cite

Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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