Tavricheskiy Mediko-Biologicheskiy Vestnik Tavricheskiy Mediko-Biologicheskiy Vestnik Таврический медико-биологический вестник 2070-8092 109280 10.29039/2070-8092-2025-28-1-97-105 Обзоры Reviews Обзоры UREMIC ENCEPHALOPATHY: MAIN FACTORS CONTRIBUTING TO ITS OCCURRENCE УРЕМИЧЕСКАЯ ЭНЦЕФАЛОПАТИЯ: ОСНОВНЫЕ ФАКТОРЫ, СПОСОБСТВУЮЩИЕ ВОЗНИКНОВЕНИЮ Шустова М. С. Shustova M. S. Крутиков С. Н. Krutikov S. N. Федосеева В. М. Fedoseeva V. M. Крутиков Евгений Сергеевич Krutikov E. S. Крымский федеральный университет имени В.И.Вернадского Crimean Federal University of a name of V.I.Vernadsky Крымский Федеральный Университет им. В.И. Вернадского RU V.I. Vernadsky Crimean Federal University RU 03 12 2025 03 12 2025 28 1 97 105 03 12 2025 https://docs.yandex.ru/docs/view?url=ya-browser%3A%2F%2F4DT1uXEPRrJRXlUFoewruO6NT0LyCHwHaAvtmDpcFCsRlxFV7RoF13ZwmZ2VOEnYJf9O3YRuOmmcwUPdBp-iRfAH9hXd71k0UO8h-ZVGeSijgkBo6GwyJS6A4iNIkDC4dHGOEvhaD193G90ld4WYZQ%3D%3D%3Fsign%3D7SByz3bpOHefhTYIyi9FlznnBKKIaYfCM7q7kfCEfls%3D&name=13_ШУСТОВА.doc&nosw=1

Обзор посвящён вопросам патогенеза уремической энцефалопатии. Проведен aнaлиз экспериментальных и клинических исследований, клинических рекомендаций, oбзорных статей из бaз данных eLIBRARY, Springer, Pubmed, Gооgle Schоlar по ключевым слoвaм: хроническая болезнь почек, патогенез, гематоэнцефалический барьер, мочевина, дисбиоз, энцефалопатия, обзор. Хроническая болезнь почек является распространенным и длительным заболеванием, характеризующимся постепенной потерей структуры и функции почек. В настоящее время в мире насчитывается более 800 миллионов человек, страдающих хронической болезнью почек. Потеря функции почек, приводит к накоплению, в том числе связанных с белками уремических токсинов, которые плохо выводятся заместительной почечной терапией. Эта системная задержка токсичных метаболитов, известная как уремический синдром, влияет на другие органы и системы. Все больные с хронической болезнью почек имеют неврологические расстройства. Диагноз уремической энцефалопатии часто основывается на ретроспективной оценке состояния больного, а соответствующие определяющие клинические и лабораторные параметры пока не используются в рутинных исследованиях. Oсложнения развиваются вследствие гемодинамических нарушений и дисфункции гематоэнцефалического барьера, изменения кишечного микробиома, обратного эффекта мочевины. Уремические токсины могут оказывать косвенное воздействие на головной мозг через сосудистую дисфункцию и гемостаз, а также прямое воздействие - токсичность для нейронных клеток, нейровоспаление и окислительный стресс для глиальных клеток и нарушение гематоэнцефалический барьер. С другой стороны, во время процедуры гемодиализа запоздалое уравновешивание уровня мочевины между кровью и ликвором ведет к отеку головного мозга и появлению неврологических расстройств. Также при хронической болезни почек состав микробиома и кишечная среда претерпевают изменения и формируется дисбиоз, что приводит к усилению ферментации белков и последующему увеличению концентрации уремических токсинов.

The review is devoted to the pathogenesis of uremic encephalopathy. An analysis of experimental and clinical studies, clinical guidelines, literature reviews from the eLIBRARY, Springer, Pubmed, Google Scholar databases was conducted using the terms: chronic kidney disease, pathogenesis, blood-brain barrier, urea, dysbiosis, encephalopathy, review. Chronic kidney disease is a common and long-term disease characterized by a gradual loss of kidney structure and function. Kidney dysfunction leads to accumulation, including protein-bound uremic toxins, which are poorly excreted by renal replacement therapy. This systemic retention of toxic metabolites, known as uremic syndrome, affects other organs and systems. The diagnosis of uremic encephalopathy is often based on a retrospective assessment of the patient’s condition, and the corresponding defining clinical and laboratory parameters are not yet used in routine studies. Complications develop due to hemodynamic disturbances and dysfunction of the blood-brain barrier, changes in the intestinal microbiome, and the reverse effect of urea. Uremic toxins can have an indirect effect on the brain through vascular dysfunction and hemostasis, as well as a direct effect - toxicity for neuronal cells, neuroinflammation and oxidative stress for glial cells and disruption of the blood-brain barrier. Anther way, during the hemodialysis procedure, delayed equilibration of the urea level between blood and cerebrospinal fluid leads to cerebral edema and the appearance of neurological disorders. The composition of the microbiome and the intestinal environment in chronic kidney disease, undergo changes and dysbiosis is formed, which leads to increased protein fermentation and a subsequent increase in the concentration of uremic toxins.

 хроническая болезнь почек патогенез гематоэнцефалический барьер мочевина дисбиоз энцефалопатия обзор. encephalopathy pathogenesis blood-brain barrier urea dysbiosis chronic kidney disease review

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