eMedicine Specialties > Nephrology > Chronic Kidney Disease

Encephalopathy, Uremic: Follow-up

Author: James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Oct 29, 2009

Follow-up

Further Inpatient Care

  • Admit patients for dialysis and further workup.

Further Outpatient Care

  • Schedule maintenance hemodialysis for patients who have ESRD.
  • Carefully monitor mental status.

Inpatient & Outpatient Medications

  • Administer medications (eg, iron, erythropoietin, phosphate binders, vitamin D analogues) for patients with ESRD to optimize their quality of life.
  • Avoid sedatives.

Transfer

  • Patients may require transfer to a facility that can provide emergent hemodialysis.

Deterrence/Prevention

  • Refer patients with chronic kidney disease to a nephrologist for regular monitoring of CrCl so that dialysis may be initiated before encephalopathy develops.

Complications

  • Seizures
  • Coma
  • Death

Prognosis

  • With prompt dialytic therapy, the mortality rate is low.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize kidney failure as the cause of encephalopathy in a patient who presents with altered mental status
  • Failure to promptly initiate dialysis in a patient with uremic encephalopathy
 


More on Encephalopathy, Uremic

Overview: Encephalopathy, Uremic
Differential Diagnoses & Workup: Encephalopathy, Uremic
Treatment & Medication: Encephalopathy, Uremic
Follow-up: Encephalopathy, Uremic
References
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References

  1. Bolton CF, Young GB. Encephalopathy of chronic renal failure. In: Neurological Complications of Renal Disease. 1990:49-74.

  2. Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. Dec 2004;107(1):1-16. [Medline].

  3. Arieff AI. Nervous system manifestations of renal failure. In: Schrier RW, ed. Diseases of the Kidney. Lippincott; 2007:2460-2482.

  4. Biasioli S, D'Andrea G, Feriani M, Chiaramonte S, Fabris A, Ronco C, et al. Uremic encephalopathy: an updating. Clin Nephrol. Feb 1986;25(2):57-63. [Medline].

  5. Biasioli S. Neurologic aspects of dialysis. In: Nissenson A, Fine R, eds. Clinical Dialysis. 2005:855-876.

  6. Moe SM, Sprague SM. Uremic encephalopathy. Clin Nephrol. Oct 1994;42(4):251-6. [Medline].

  7. Deguchi T, Isozaki K, Yousuke K, Terasaki T, Otagiri M. Involvement of organic anion transporters in the efflux of uremic toxins across the blood-brain barrier. J Neurochem. Feb 2006;96(4):1051-9. [Medline].

  8. De Deyn PP, Vanholder R, Eloot S, et al. Guanidino compounds as uremic (neuro)toxins. Semin Dial. Jul-Aug 2009;22(4):340-5. [Medline].

  9. Liu M, Liang Y, Chigurupati S, Lathia JD, Pletnikov M, Sun Z, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol. Jul 2008;19(7):1360-70. [Medline].

  10. Yamamoto T, Satomura K, Okada S, et al. Risk factors for neurological complications in complete hemolytic uremic syndrome caused by Escherichia coli O157. Pediatr Int. Apr 2009;51(2):216-9. [Medline].

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Further Reading

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Keywords

uremic encephalopathy, encephalopathy, uremia, encephalopathies, metabolic encephalopathy, treatment encephalopathy, uremic syndrome

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Contributor Information and Disclosures

Author

James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Medical Editor

Donald A Feinfeld, MD, FACP, FASN, Consulting Staff, Division of Nephrology & Hypertension, Beth Israel Medical Center
Donald A Feinfeld, MD, FACP, FASN is a member of the following medical societies: American Academy of Clinical Toxicology, American Society of Hypertension, American Society of Nephrology, and National Kidney Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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