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Uremic Encephalopathy Follow-up

  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jun 05, 2014
 

Further Outpatient Care

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

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  • Admit patients for dialysis and further workup.
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Inpatient & Outpatient Medications

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

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

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

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  • Seizures
  • Coma
  • Death
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Prognosis

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  • With prompt dialytic therapy, the mortality rate is low.
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Contributor Information and Disclosures
Author

James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, Central Society for Clinical and Translational Research

Disclosure: Partner received salary from Alexion for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

Donald A Feinfeld, MD, FACP, FASN Consulting Staff, Division of Nephrology and Hypertension, Beth Israel Medical Center

Disclosure: Nothing to disclose.

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

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

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

  4. Seifter JL, Samuels MA. Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol. 2011 Apr. 31(2):139-43. [Medline].

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

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

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

  8. 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. 2006 Feb. 96(4):1051-9. [Medline].

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

  10. 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. 2008 Jul. 19(7):1360-70. [Medline].

  11. Nomoto K, Scurlock C, Bronster D. Dexmedetomidine controls twitch-convulsive syndrome in the course of uremic encephalopathy. J Clin Anesth. 2011 Dec. 23(8):646-8. [Medline].

  12. 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. 2009 Apr. 51(2):216-9. [Medline].

  13. Schmidt M, Sitter T, Lederer SR, Held E, Schiffl H. Reversible MRI changes in a patient with uremic encephalopathy. J Nephrol. 2001 Sep-Oct. 14(5):424-7. [Medline].

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