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Uremic Encephalopathy Treatment & Management

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

Medical Care

No medications are specific to the treatment of encephalopathy.

  • The presence of uremic encephalopathy in a patient with either acute kidney injury or chronic kidney failure is an indication for the initiation of dialytic therapy (ie, hemodialysis, peritoneal dialysis, continuous renal replacement therapy). After beginning dialysis, the patient generally improves clinically, although EEG findings may not improve immediately.
  • In patients with end-stage renal disease (ESRD), EEG abnormalities generally improve after several months but may not completely normalize.
  • Address the following factors when treating uremic encephalopathy, which are also included in the standard care of any patient with ESRD:
    • Adequacy of dialysis
    • Correction of anemia
    • Regulation of calcium and phosphate metabolism
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Consultations

See the list below:

  • Consult a neurologist if symptoms do not improve upon initiation of dialysis therapy.
  • Consult a vascular surgeon for placement of vascular access in patients with ESRD.
  • Refer patients with ESRD to a dietitian familiar with renal diseases.
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Diet

See the list below:

  • To avoid malnutrition in patients with ESRD, maintain adequate protein intake (1.2 g/kg/d) and initiate dialysis (despite the presence of encephalopathy).
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Activity

Instruct patients with significant symptoms to continue bed rest.

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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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