Uremic Encephalopathy and Other Brain Disorders Associated with Renal Failure

Abstract

Kidney failure is one of the leading causes of disability and death and one of the most disabling features of kidney failure and dialysis is encephalopathy. This is probably caused by the accumulation of uremic toxins. Other important causes are related to the underlying disorders that cause kidney failure, particularly hypertension. The clinical manifestations of uremic encephalopathy include mild confusional states to deep coma, often with associated movement disorders, such as asterixis. Most nephrologists consider cognitive impairment to be a major indication for the initiation of renal replacement therapy with dialysis with or without subsequent transplantation. Sleep disorders, including Ekbom's syndrome (restless legs syndrome) are also common in patients with kidney failure. Renal replacement therapies are also associated with particular neurologic complications including acute dialysis encephalopathy and chronic dialysis encephalopathy, formerly known as dialysis dementia. The treatments and prevention of each are discussed.

Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation

“…The manifestations of this brain disorder include various neurologic symptoms such as movement disorders (tremor, asterixis, myoclonus), cognitive disorders, and alteration in mental status. 10,11 UE presents 3 patterns of imaging findings: basal ganglia involvement, [12][13][14] cortical or subcortical involvement, 15,16 and white matter involvement. 17,18 Basal ganglia involvement is more common in Asian patients with DM.…”

Cognitive Disorders and Dementia in CKD

“…78 Various uremic toxins have been implicated in the pathogenesis of cognitive impairment. 79 DeDeyn et al reported that cerebrospinal fluid and brain levels of some guanidine compounds, such as creatinine, guanidine, guanidinosuccinic acid, and methylguanidine, are substantially elevated in uremic patients. 80 Interestingly, these high toxin concentrations (up to 10-fold higher in CKD patients than in controls) were found in brain regions that play a determinant role in cognition, such as the thalamus, the mammillary bodies, and the cerebral cortex.…”

Starfruit neurotoxicity mimicking an acute brainstem stroke

“…Such cases can present with complex mental changes, confusion, delirium, psychosis, motor disturbances (tremor, myoclonus, asterixis), hyperreflexia, and disturbances of gait and speech-which are more commonly settled on chronic rather than acute failures [5]. Nevertheless, ophthalmoparesis and asymmetric cranial nerve palsies are not common in this setting.…”