https://scholars.lib.ntu.edu.tw/handle/123456789/467756
標題: | Skin denervation and its clinical significance in late-stage chronic kidney disease | 作者: | CHI-CHAO CHAO VIN-CENT WU Tan C.-H. Wang Y.-M. MING-TSUNG TSENG Wu P.-C. Lin Y.-H. Lin W.-M. KWAN-DUN WU SUNG-TSANG HSIEH |
公開日期: | 2011 | 卷: | 68 | 期: | 2 | 起(迄)頁: | 200-206 | 來源出版物: | Archives of Neurology | 摘要: | Objective: To investigate the skin innervation and its clinical significance in late-stage chronic kidney disease (CKD). Design: Case series. Setting: National Taiwan University Hospital, Taipei, Taiwan. Patients: Forty consecutive nondiabetic patients with late-stage CKD (14 female and 26 male; mean [SD] age, 60.7 [12.3] years), including 2 cases with stage 3 CKD, 6 with stage 4 CKD, and 32 with stage 5 CKD, ie, end-stage kidney disease. Interventions: Clinical evaluation of neurological deficits, nerve conduction study, autonomic function tests, and a 3-mm-diameter skin biopsy specimen taken from the distal leg. Main Outcome Measures: Quantitation of epidermal innervation, parameters of nerve conduction study, R-R interval variability, and sympathetic skin response. Results: Clinically, 21 patients (52.5%) were symptomatic with paresthesia over the limbs or autonomic symptoms. The intraepidermal nerve fiber (IENF) density was markedly reduced in patients with CKD compared with age and sex-matched controls (mean [SD], 2.8 [2.0] vs 8.6 [2.8] fibers/mm; P<.001). Skin denervation was observed in 27 patients (67.5%). Fifteen patients (37.5%) had abnormalities on nerve conduction studies, and 29 patients (72.5%) had abnormal results on autonomic function tests. By analysis with multiple regression models, the IENF density was negatively correlated with the duration of renal disease (P=.02). Additionally, the R-R interval variability at rest was linearly correlated with the IENF density (P=.02) and the absence of sympathetic skin responses at the soles was associated with reduced IENF density (P=.03). Conclusions: Small-fiber sensory and autonomic neuropathies constitute the major form of neuropathy in latestage CKD. Furthermore, skin denervation was associated with the duration of renal disease. ?2011 American Medical Association. All rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-79951540678&doi=10.1001%2farchneurol.2010.372&partnerID=40&md5=bcfe85c2009c0121052b1482938a55f8 https://scholars.lib.ntu.edu.tw/handle/123456789/467756 |
ISSN: | 0003-9942 | DOI: | 10.1001/archneurol.2010.372 | SDG/關鍵字: | adult; aged; article; autonomic denervation; autonomic dysfunction; autonomic neuropathy; chronic kidney disease; clinical article; controlled study; denervation; female; human; kidney failure; male; multiple regression; nerve conduction; neurologic disease; paresthesia; priority journal; sensory neuropathy; skin biopsy; Taiwan; Aged; Autonomic Pathways; Biopsy; Case-Control Studies; Disease Progression; Extremities; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Nerve Fibers; Neural Conduction; Paresthesia; Regression Analysis; Severity of Illness Index; Skin; Taiwan |
顯示於: | 解剖學暨細胞生物學科所 |
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