The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis
| Autor: | Revathy Manickavasigar, David A Prentice, Ashley Irish, Aanchal Agarwal, Adam Youssef, Thomas Chemmanam |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Movement disorders Lentiform nucleus medicine.medical_treatment Gastroenterology 03 medical and health sciences 0302 clinical medicine Basal Ganglia Diseases Renal Dialysis Risk Factors Internal medicine Diabetes mellitus medicine Humans 030212 general & internal medicine Renal Insufficiency Chronic Dialysis Retrospective Studies Athetosis Movement Disorders business.industry Infant Chorea Syndrome General Medicine Prognosis medicine.disease Metformin Diabetes Mellitus Type 2 Child Preschool Lactic acidosis Acidosis Lactic Female medicine.symptom business 030217 neurology & neurosurgery Kidney disease |
| Zdroj: | QJM: An International Journal of Medicine. 115:359-366 |
| ISSN: | 1460-2393 1460-2725 |
| DOI: | 10.1093/qjmed/hcab140 |
| Popis: | Summary Background Acute extrapyramidal movement disorders in dialysis patients are rare, inconsistently defined and have uncertain aetiology and prognosis. Aim Define diagnostic criteria, prognosis and risk factors Design and Methods Retrospective case series review of 20 patients (14 female, mean age 62 years) receiving dialysis for a median of 15 (interquartile range 4–35) months who presented with acute parkinsonism (AP = 11) or chorea/athetosis (CA = 9). Results All patients had type 2 diabetes (HbA1c 6.8 ± 1.0) and had received metformin. Lactic acidosis was present in 2 patients at presentation and serum lactate was elevated in 7/15 patients tested. No patient had abnormal copper or thyroid metabolism and 5/8 patients tested returned marginal abnormalities in heavy metal screening. Magnetic resonance imaging (MRI) revealed characteristic bilateral symmetric T2 hyperintensity of the basal ganglia (BG), predominantly putamen and globus pallidus (the lentiform nucleus) and more extensive involvement of the external and internal capsules in patients with AP presentation. Post-mortem demonstrated cytotoxic necrosis of the BG. Therapy included thiamine, intensive dialysis and cessation of metformin. Two patients died acutely, nine recovered and nine had residual symptoms. Median survival did not differ by presentation: AP 24 [95% confidence interval (CI) 21–27] and CA 33 (95% CI 32–35) months, P = 0.21. Conclusions There are two distinct clinical extrapyramidal movement disorders associated with specific diagnostic MRI imaging that support the diagnosis of the extrapyramidal syndromes of chronic kidney disease and dialysis. The associations with diabetes, metformin and metabolic acidosis suggest a common pathogenic mechanism but require additional study. Early recognition and treatment may improve outcomes. |
| Databáze: | OpenAIRE |
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