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常染色体显性遗传性多囊肾患者的疼痛综合征

Authors
Theodore I Steinman, MD
Samir M Parikh, MD
Section Editor
Ronald D Perrone, MD
Deputy Editor
Alice M Sheridan, MD
Translators
马迎春, 主任医师

引言

超过60%的常染色体显性遗传性多囊肾(autosomal dominant polycystic kidney disease, ADPKD)患者存在腹痛和腰痛[1]。腹痛通常与肾囊肿有关，但也可能与肝囊肿有关。疼痛可能呈急性或慢性。

大部分患者都可有效治疗，但少数患者会出现严重影响日常活动的慢性疼痛[2]。

详尽的病史能为疼痛的潜在病因提供良好线索，而影像学检查是诊断的重要辅助手段。疼痛常不能被很好地控制，因为许多临床医生会在患者主诉疼痛但没有了解病因的情况下，反射性地给予患者麻醉剂。

本专题将概述有关ADPKD疼痛的病理生理学和常见表现，并介绍其初始治疗的阶梯式治疗方法(侧重于肾脏相关疼痛)。

ADPKD的一般治疗及肾脏和肾外表现将单独讨论。 (参见“常染色体显性遗传性多囊肾的病程和治疗”和“常染色体显性遗传性多囊肾病的肾脏表现”和“常染色体显性遗传性多囊肾的肾外表现”)

                      

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-01.
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References
Top
  1. Gabow PA. Autosomal dominant polycystic kidney disease--more than a renal disease. Am J Kidney Dis 1990; 16:403.
  2. Hogan MC, Norby SM. Evaluation and management of pain in autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis 2010; 17:e1.
  3. Ansell J, Gee W, Bonica J. Diseases of the kidney and ureter. In: Management of Pain, 2nd ed., Bonica J (Ed), Lee & Febiger, Philadelphia 1990. Vol 2, p.1232.
  4. Ammons WS. Renal afferent input to thoracolumbar spinal neurons of the cat. Am J Physiol 1986; 250:R435.
  5. Ammons WS. Bowditch Lecture. Renal afferent inputs to ascending spinal pathways. Am J Physiol 1992; 262:R165.
  6. Nam TS, Baik EJ, Shin YU, et al. Mechanism of transmission and modulation of renal pain in cats; effects of transcutaneous electrical nerve stimulation on renal pain. Yonsei Med J 1995; 36:187.
  7. Gabow PA. Autosomal dominant polycystic kidney disease. N Engl J Med 1993; 329:332.
  8. Gibson P, Watson ML. Cyst infection in polycystic kidney disease: a clinical challenge. Nephrol Dial Transplant 1998; 13:2455.
  9. Ravich L, Lerman PH, Drabkin J. Ruptured renal cyst in polycystic disease. Urology 1976; 7:60.
  10. Carels RA, van Bommel EF. Ruptured giant liver cyst: a rare cause of acute abdomen in a haemodialysis patient with autosomal dominant polycystic kidney disease. Neth J Med 2002; 60:363.
  11. Bajwa ZH, Gupta S, Warfield CA, Steinman TI. Pain management in polycystic kidney disease. Kidney Int 2001; 60:1631.
  12. Delaney VB, Adler S, Bruns FJ, et al. Autosomal dominant polycystic kidney disease: presentation, complications, and prognosis. Am J Kidney Dis 1985; 5:104.
  13. Bennett WM, Elzinga LW, Barry JM. Polycystic kidney disease: II. Diagnosis and management. Hosp Pract (Off Ed) 1992; 27:61.
  14. Ubara Y, Katori H, Tagami T, et al. Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis. Am J Kidney Dis 1999; 34:926.
  15. Tarrass F, Benjelloun M. Acute abdomen caused by spontaneous renal cyst rupture in an ADPKD haemodialysed patient. Nephrology (Carlton) 2008; 13:177.
  16. Chauveau D, Fakhouri F, Grünfeld JP. Liver involvement in autosomal-dominant polycystic kidney disease: therapeutic dilemma. J Am Soc Nephrol 2000; 11:1767.
  17. Bajwa ZH, Sial KA, Malik AB, Steinman TI. Pain patterns in patients with polycystic kidney disease. Kidney Int 2004; 66:1561.
  18. Milutinovic J, Fialkow PJ, Agodoa LY, et al. Autosomal dominant polycystic kidney disease: symptoms and clinical findings. Q J Med 1984; 53:511.
  19. Segura JW, King BF, Jowsey SG. Chronic pain and its medical and surgical management in renal cystic diseases. In: Polycystic Kidney Disease, Watson ML, Torres VE (Eds), Oxford University Press, Oxford 1996. p.462.
  20. Grantham JJ, Torres VE, Chapman AB, et al. Volume progression in polycystic kidney disease. N Engl J Med 2006; 354:2122.
  21. Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd 2003; 10:325.
  22. Maher CG. Effective physical treatment for chronic low back pain. Orthop Clin North Am 2004; 35:57.
  23. de Mattos AM, Olyaei AJ, Bennett WM. Pharmacology of immunosuppressive medications used in renal diseases and transplantation. Am J Kidney Dis 1996; 28:631.
  24. Henrich WL, Agodoa LE, Barrett B, et al. Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. Am J Kidney Dis 1996; 27:162.
  25. Whitcomb DC, Block GD. Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA 1994; 272:1845.
  26. Eisenach JC, De Kock M, Klimscha W. alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology 1996; 85:655.
  27. Tryba M, Gehling M. Clonidine--a potent analgesic adjuvant. Curr Opin Anaesthesiol 2002; 15:511.
  28. Smith H, Elliott J. Alpha(2) receptors and agonists in pain management. Curr Opin Anaesthesiol 2001; 14:513.
  29. Dimou P, Paraskeva A, Papilas K, Fassoulaki A. Transdermal clonidine: does it affect pain after abdominal hysterectomy? Acta Anaesthesiol Belg 2003; 54:227.
  30. Goyagi T, Tanaka M, Nishikawa T. Oral clonidine premedication enhances postoperative analgesia by epidural morphine. Anesth Analg 1999; 89:1487.
  31. Lee YH, Lee WC, Chen MT, et al. Acupuncture in the treatment of renal colic. J Urol 1992; 147:16.
  32. Resim S, Gumusalan Y, Ekerbicer HC, et al. Effectiveness of electro-acupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy. Urol Res 2005; 33:285.
  33. Osenbach RK, Harvey S. Neuraxial infusion in patients with chronic intractable cancer and noncancer pain. Curr Pain Headache Rep 2001; 5:241.
  34. Torres VE, Chapman AB, Devuyst O, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med 2012; 367:2407.