Uremic encephalopathy

An organic brain disorder from acute or chronic renal failure.

Usually occurs when creatinine clearance falls and remains below 15 cc/minute.

Symptoms include: fatigue, lassitude, seizures and coma.

Its progression and severity are dependent on the rate of decline in renal function.

Symptoms usually worse with acute renal failure.

Symptoms reversed by dialysis.

Likely many toxins that accumulate with renal failure contribute to the process.

Parathyroid hormone probable contributes to this process.

Secondary hyperparathyroidsism that occurs with renal failure is associated with EEG changes which improve with medical suppression of parathyroid levels or parathyroidectomy.

Suspected that parathyroid increase causes increases in intracellular calcium in brain cells.

Dialysis improves encephalopathy but it not associated with a significant reduction in parathyroid levels.

Associated with increased plasma and cerebrospinal fluid levels of glycine with reductions in glutamine and GABA levels.

Associated with changes in dopamine and serotonin metabolism in the brain.

Most patients with les than 10% of renal function have some degree of encephalopathy.

Symptoms are reversible with dialysis and with recovery of acute renal failure.

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