Uremic Encephalopathy

Excerpt

Uremic encephalopathy is defined as cerebral dysfunction caused by the accumulation of toxins due to acute or chronic renal failure. This condition typically develops in patients with acute or chronic renal failure whose estimated glomerular filtration rate (eGFR) is below 15 mL/min. The clinical presentation of uremic encephalopathy is broad, varying from subtle to florid, and the clinical course is always progressive when left untreated. Uremic encephalopathy is at least partially reversible with the initiation of renal replacement therapy, making it a clear indication to start such treatment.

The syndrome likely results from alterations in hormonal metabolism, retention of uremic solutes, changes in electrolyte and acid-base homeostasis, blood-brain barrier transport, changes in vascular reactivity, and inflammation. Diagnosis of uremic encephalopathy is challenging, as there are no specific clinical, laboratory, or imaging findings. The condition is often diagnosed retrospectively when symptoms improve after dialysis or kidney transplantation. If symptoms do not improve after clearing toxic solutes, other potential causes should be investigated.