Dysimmune polyneuropathies are the etiologically heterogeneous group of diseases with autoimmune damage to the peripheral nervous system. The rarity of these diseases doesn’t exclude the possibility of their development or exacerbation in patients infected with SARS‑CoV‑2, which will require timely differential diagnosis and urgent specific therapy. The article summarizes current information on the mechanisms of development, clinical features, diagnosis and management of acute and chronic dysimmune polyneuropathies in the context of the COVID‑19 pandemic.
Introduction. Cerebral microangiopathy (CMA), being the leading cause of vascular cognitive impairment and strokes, has a number of causes, among which chronic kidney disease (CKD) and programmed hemodialysis (HD) are the least studied.Purpose of the study: to determine the frequency of CMA neuroimaging markers and risk factors for its development in patients receiving renal replacement therapy for a long time using the programmed HD.Material and methods: the study involved 70 patients who had been on programmed HD for 10 months or more. Clinical neurological examination, laboratory tests and brain MRI were performed. The analysis of CMA neuroimaging markers was carried out in accordance with the STRIVE recommendations. Cerebral Small Vessel Disease Score (CSVDS) was used to quantify the overall severity of MR imaging markers of CMA.Results. Among 70 examined (29 men and 41 women) aged 53.0 ± 14.2 years, average HD experience – 70.0 ± 39.5 months, the main clinical manifestations of CMA were cognitive impairment (82.9%, n = 58), emotional disorders (61.4%, n = 43), sleep disorders (38.6%, n = 27), pseudobulbar syndrome (17.1%, n = 12), walking disorders (8.6%, n = 6), acute lacunar syndromes (7.1%, n = 5) and pelvic dysfunction (4.3%, n = 3). CMA neuroimaging markers of varying severity were found in 100% of cases. Expansion of perivascular spaces (100%, n = 70) and white matter hyperintensities (81.4%, n = 57) prevailed in the structure of CMA imaging markers. Cortical atrophy (67%, n = 47), cerebral microbleeds (47%, n = 33), asymptomatic lacunae (35.7%, n = 25) and minor subcortical infarctions (2.9%, n = 3) were less common. Mild CMA (1–2 points on the CSVDS scale) was determined in 38 patients (54.3%), severe CMA (3–4 points on the CSVDS scale) – in 32 patients (45.7%). The presence of uncontrolled arterial hypertension (OR 1.85, p < 0.05), intradialysis hypertension (OR 2.8, p < 0.05), dialysis vegetative polyneuropathies (OR 2.75, p < 0.05), type 2 diabetes mellitus (OR 5.7, p < 0.05) and the experience of programmed HD (more than 50 months) (OR 3.1, p < 0.05) were prognostic signifi cance for the development of severe CMA in dialysis patients.Conclusion. All patients with end-stage CKD who have been on programmed HD for a long time are shown to undergo the brain MRI in order to timely diagnose CMA imaging markers and possible correction of therapy.
The deficit of vitamins in patients receiving the long-term hemodialysis is discussed in the modern literature. Vitamin deficiency in a dialysis patient can be explained by the peculiarity of the diet recommendations, the need to take a number of medications, impaired absorption of vitamins in the digestive tract, poor appetite, uremic anorexia, depression, limited ability to buy and cook food, as well as losses of vitamins during the procedure of program hemodialysis. An analytical review of current (2011 and later) publications containing a comprehensive analysis of data on the status of water-soluble vitamins and its role in the development of neurological disorders in dialysis patients is provided. There is a high risk of deficiency of various water soluble vitamins and neurological disorders, such as vitamin B1 deficiency and thiamine deficiency encephalopathy and polyneuropathy, vitamin B6 deficiency and pyridoxine deficiency polyneuropathy, folic acid metabolism disorders, as well as vitamin B12 and the development of hyperhomocysteinemia, cognitive and depressive disorders, strokes, restless legs syndrome and dialysis polyneuropathy among the patients with end-stage chronic kidney disease and program hemodialysis. Vitamin C deficiency and the development of severe asthenic syndrome with insomnia and depression are described in dialysis patients. It seems necessary to revise the traditional nutritional approaches to the dialysis patients based on the analysis of the literature. Special attention is paid to the possible addition of such water-soluble vitamins as B1, B6, B9, B12 and C. Timely diagnosis of vitamin deficiency conditions and neurological disorders in patients on program hemodialysis, the development of methods for their correction and their introduction into clinical practice would improve the life expectancy and quality of life of dialysis patients.
Introduction: The problem of acute and chronic cerebrovascular disorders in dialysis patients remains the most urgent. Risk factors for cerebrovascular diseases in CKD and dialysis patients can be conditionally divided into “traditional” (arterial hypertension, diabetes mellitus, hypercholesterolemia) and “specific” (associated with renal pathology and dialysis procedures). The spectrum of specific factors of cerebrovascular risk in patients with dialysis stage of the CKD includes specific dialysis factors that form during programmed HD, as well as impaired phosphorus-calcium metabolism and calcification of the arterial microvasculature, increased blood levels of β2-microglobulin, homocysteine, malondialdehyde and superoxide dismutase, a decrease in the level of nitric oxide (II) metabolites, development of nephrogenic anemia and dysfunction of blood cells, malnutrition and dietary features of patients with renal pathology, accumulation of uremic toxins and toxins of intestinal bacteria, etc. Opportunistic gut microorganisms can produce uremic toxins, which are associated with an increased risk of inflammation, increased oxidative stress, and a higher risk of cardiovascular disease (CVD). Description of the spectrum of risk factors for cerebrovascular pathology in dialysis patients and effective control over them seems to be an effective strategy aimed at increasing the duration and quality of life in patients receiving renal replacement therapy. The aim of the investigation was to study the species composition of colon microbiocenosis in patients with CKD receiving programmed HD treatment and to evaluate the effectiveness of its correction using a new immobilized synbiotic. Materials and methods: Samples of colon microbiota from 62 patients undergoing programmed hemodialysis were studied before and after a course of diet therapy that included probiotic components, in particular, the immobilized synbiotic LB-complex L. Isolation of microorganisms was carried out according to our original method; for bacteria identification, a MALDI-TOF Autoflex speed mass spectrometer (Bruker Daltonik, Germany) was used in the Biotyper program mode. The results were assessed using the criteria proposed by the authors and based on the OST 91500.11.0004-2003. The efficacy of the immobilized synbiotic was determined based on the clinical data, questionnaires, and bacteriological tests. Results: In patients receiving programmed hemodialysis (before the start of the diet therapy), chronic moderate inflammation and azotemia were found. Dysbiotic changes in microbiocenosis were revealed in all the examined patients; in the absence or suppression of lacto- and bifidoflora, the number and diversity of Bacteroides spp., Clostridium spp., Collinsella spp., Eggerthella spp. and other bacteria increased, which was consistent with the theory of functional redundancy of gut microbiota. From the answers to the questionnaires, a decrease in the quality of life was found (up to 70 points out of 100) according to six of the eight scales used. After the combined therapy using the synbiotic LB-complex L in the study group, 56% of the examined patients showed their microbiocenosis restored to normal; no grade III dysbiosis was detected in any patient. There was a significant decrease in CRP and ESR in these patients and an improvement in the quality of life by criteria reflecting physical health. Conclusion: Acute/chronic CVD in patients with CKD of the pre-dialysis and dialysis periods are the most frequent and formidable complications. The spectrum of “traditional” and “specific” CV risk factors in dialysis patients will be described in the chapter. Special attention will be paid to the intestinal microbiota and opportunistic intestinal microorganisms. The aim was to study the species composition of colon microbiocenosis in HD patients, and to evaluate the effectiveness of its correction using a new immobilized synbiotic. Materials and Methods. Samples of colon microbiota from 62 HD patients were studied before/after a course of diet therapy that included probiotic components, the immobilized synbiotic LB-complex L. MALDI-TOF Autoflex speed mass spectrometer was used in the Biotyper program mode. The efficacy of the immobilized synbiotic was determined based on the clinical data, questionnaires, and bacteriological tests. Results. Dysbiotic changes in microbiocenosis were revealed in all patients; in the absence/suppression of lacto-and bifidoflora, the number and diversity of Bacteroides spp.,Clostridium spp.,Collinsella spp.,Eggerthella spp. and other bacteria increased. After the combined therapy using the synbiotic LB-complex L in the study group, 56% of the examined patients showed their microbiocenosis restored to normal; no grade III dysbiosis was detected in any patient.
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