Uremic Encephalopathy Pathology

Encephalopat
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Uremic
DEFINITION
Uremic encephalopathy (UE) is an acute or subacute organic brain syndrome that generally
appears in patients with acute or chronic renal failure when glomerular filtration falls below 10% of
normal.
Metabolic encephalopathy is usually characterized by a history of disorientation and

confusion that precedes the onset of stupor or coma in the absence of motor signs.
There is frequently asterixis, myoclonus, tremor, and in comatose patients the
presence of focal or generalized seizures provides evidence of metabolic
dysfunction. . Acute or chronic renal failure produces uremic encephalopathy. Despite
extensive research, the exact cause of brain dysfunction in uremia remains
unidentified, with parathyroid hormone, imbalances in brain amino acids with
modification of neurotransmitters, and a series of neurotoxins such as methylguanidine
and molecules being proposed as causal agents. Medium-sized.
ETIOPATHOGENESIS
The exact cause of uremic encephalopathy (UE) is unknown. The following have been
proposed as causal agents: hormonal disorders, oxidative stress, accumulation of metabolites,
imbalance between excitatory and inhibitory neurotransmitters and alteration of intermediate
metabolism, which were identified as factors that contribute to the pathophysiological
explanation of EU. .
Physical signs:
• Myoclonus, cramps or fasciculations (uremic cramps and convulsions syndrome postulated by

Adams et al.)
• Asterixis
• Dysarthria
• Agitation
• Tetany
• Seizures, usually generalized, tonic-clonic
• Confusion, stupor, and other mental status alterations
• Eat
Dialysis encephalopathy (or dialysis dementia) is a subacute, progressive and fatal disease that
occurs in patients undergoing long-term hemodialysis. It is believed to be part of a multisystem
disease that includes encephalopathy, osteomalacia, proximal myopathy, and anemia.
Causes of EU
The exact cause of EU is unknown. Possible etiologies are metabolite accumulation and,
perhaps, imbalance in excitatory and inhibitory neurotransmitters. Abnormal parathyroid
hormone and calcium may also be contributing factors.
Laboratory studies
- Abnormal ionogram and renal function studies
- Routine cerebrospinal fluid studies tend to be normal
- Imaging studies
- Brain Imaging Has Little Value
Computed tomography and magnetic resonance imaging studies show cerebral atrophy and
secondary ventricular dilation. In the presence of acute changes in mental status, these studies
allow intracranial hemorrhage and subdural hematoma to be excluded. The MRI has improved
in parallel with the improvement in creatininemia and blood urea nitrogen levels.
Procedures
Hemodialysis
Peritoneal dialysis
Kidney transplant
Neurosurgical intervention in case of intracranial hemorrhage or subdural hematoma
Histological findings
Meningeal fibrosis, glial changes, edema, vascular degeneration, focal and diffuse neuronal
degeneration, and focal demyelination
You can also see
-Small infarcts, probably due to hypertension or focal necrosis -Acute cerebellar granular cell
necrosis
Patients with dementia during dialysis show spongiform alterations in the external part of the
cortical layers, with increased serum aluminum levels in the cerebral cortex. Other changes
include neuronal loss, accumulation of the pigment lipofuscin, and neurofibrillary degeneration
in the motor cortex and in the red, dentate, and olivary nuclei.
Medical treatment
Correction of the metabolic disorder, commonly through dialysis (hemodialysis or peritoneal) or

kidney transplant, with which kidney function improves.
Seizures can be treated with anticonvulsants, in lower doses than usual.
Emergency treatment of subdural hematoma or intracranial hemorrhage Adjust the doses of the
medications that the patient receives to the degree of kidney function
Treatment of hypertension and infections
Surgical treatment
Surgery in EU is limited to kidney transplant, subdural hematoma or intracranial hemorrhage, in

addition to vascular access.

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Encephalopat

Metabolic encephalopathy is usually characterized by a history of disorientation and

• Myoclonus, cramps or fasciculations (uremic cramps and convulsions syndrome postulated by

• Seizures, usually generalized, tonic-clonic

• Confusion, stupor, and other mental status alterations

- Abnormal ionogram and renal function studies

- Routine cerebrospinal fluid studies tend to be normal

- Brain Imaging Has Little Value

You can also see

Correction of the metabolic disorder, commonly through dialysis (hemodialysis or peritoneal) or

Treatment of hypertension and infections

Surgery in EU is limited to kidney transplant, subdural hematoma or intracranial hemorrhage, in

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