4 research outputs found
The Role of Ultrasonographic Monitoring for Hip Joint Changes in Patients with Chronic Renal Failure
Amyloidosis related carpal tunel syndrome in patients with chronic renal disease: case report
Bolesnici s kroniÄnim bubrežnim zatajenjem imaju poviÅ”ene vrijednosti AGE (krajnje produkte glikolizacije). AGE nastaju tijekom procesa glikolizacije i oksidativnim reakcijama, kao dio procesa
kroniÄne upale. Amiloidoza je Äesta komplikacija kod bolesnika s kroniÄnim bubrežnim zatajenjem, a posljedica je nemoguÄnosti izluÄivanja Ī²2-mikroglobulina. Vremenskim trajanjem hemodijalize poveÄava se broj bolesnika kod kojih se histoloÅ”ki može utvrditi amiloidoza. TreÄina bolesnika koji idu na hemodijalizu manje od 4 godine ima histoloÅ”ke znakove amiloidoze, a redovito se javlja kod 90% bolesnika nakon 5-7 godina hemodijalize. U poÄetnom stadiju prisutni su samo histoloÅ”ki znakovi bolesti, dok se kliniÄki znakovi
javljaju kasnije. Jedan od prvih kliniÄkih znakova amiloidoze je sindrom karpalnog tunela. Javlja se kod treÄine bolesnika koji idu 5-10 godina na hemodijalizu, a nakon 20 godina hemodijalize gotovo 100% bolesnika ima sindrom karpalnog tunela. Iako sindrom karpalnog tunela ne dovodi do fatalnog ishoda, njegovim zanemarivanjem dolazi do oÅ”teÄenja n. medianusa u karpalnom tunelu i atrofije miÅ”iÄa Å”ake s teÅ”kim funkcionalnim ispadima. NaÅ” bolesnik je lijeÄen operativno i nakon zavrÅ”ene rehabilitacije zaostao je dobar funkcionalni i anatomski rezultat. Zbog toga je pravovremeno dijagnosticiranje i dekompresija n. medianusa preduvjet za uspjeÅ”no lijeÄenje sindroma karpalnog tunela. Za razliku od ālow-fluxā hemodijalizatora, novi āhigh-fluxā su viÅ”e biokompatibilni i mogu odstraniti beta-2-mikroglobulin, pa se oÄekuju rjeÄe komplikacije u smislu sindroma karpalnog tunela zbog amiloidoze kod bolesnika s kroniÄnim bubrežnim zatajenjem.Patients with CRF (chronic renal failure) have elevated AGE (advanced glycation end products). AGE are formed during glycation and oxidative stress, and accumulation of AGE occurs especially in CRF and plays a major pathogenic role. Amyloidosis is a common complication in patients with chronic renal failure.
Amyloidosis develops due to impossible Ī²2-microglobulin excretion. The number of patients with histologically demonstrable amyloidosis increases with the length of hemodialysis. Histologic signs of amyloidosis are found in one third and 90% of patients undergoing hemodialysis for up to 4 years and 5-7 years, respectively. Histologic signs alone are present initially, whereas clinical signs develop later. The carpal tunnel syndrome is one of the first clinical signs of amyloidosis. The syndrome develops in one third of patients undergoing hemodialysis for 5-10 years and nearly 100% of those treated by hemodialysis for 20 years. The carpal tunnel syndrome is not a fatal disease; however, if left untreated, it leads to median nerve lesion and atrophy of the hand musculature with severe functional deficits. The patient presented was operatively treated, followed by rehabilitation that resulted in satisfactory functional and anatomical outcome. Accordingly, timely diagnosis and median nerve decompression are the main preconditions for successful management of the carpal tunnel syndrome. In contrast to ālow-fluxā hemodialyzers, the new āhigh-fluxā devices offer appropriate biocompatibility and Ī²2-microglobulin removal, thus a lower rate of
complications such as carpal tunnel syndrome due to amyloidosis is expected in patients with chronic renal failure