Mechanisms of Uraemic Encephalopathy

Abstract

New techniques of both pharmacological and dietary therapy have the potential to decrease the incidence of acute and chronic end-stage renal disease (Brenner et al. 1982; Klahr et al. 1983). Acute renal failure is a major complication among patients being treated in the intensive therapy unit (ITU), and among patients with either acute or chronic renal failure, nervous system dysfunction remains a major cause of disability. Such patients will manifest a variety of neurological disorders (Raskin and Fishman 1976; Teschan and Arieff 1985; Teschan et al. 1979). Even after the institution of adequate dialysis therapy, patients with acute renal failure (ARF) may continue to manifest subtle nervous system dysfunction, such as impaired mental activity, generalized weakness, sexual dysfunction and peripheral neuropathy (Raskin and Fishman 1976; Teschan and Arieff 1985; Teschan et al. 1979; Said et al. 1983). Patients with chronic renal failure who have not yet received dialytic therapy may develop symptoms ranging from mild sensorial clouding to delirium and coma (Raskin and Fishman 1976; Teschan and Arieff 1985). The dialytic treatment of end-stage renal disease has itself been associated with at least three distinct disorders of the central nervous system. These include dialysis disequilibrium syndrome, progressive intellectual dysfunction and dialysis dementia (Fraser and Arieff 1988b). Dialysis disequilibrium syndrome occurs in a small number of patients and is a consequence of the initiation of dialysis therapy. Dialysis dementia is a progressive and generally fatal encephalopathy which can affect patients on chronic haemodialysis as well as children with chronic renal failure who have not been treated with dialysis (Baluarate et al. 1977; Andreoli et al. 1984). It is generally not a problem in patients in the lTV, nor is progressive intellectual dysfunction, which may also occur in many patients who are being freated with maintenance dialysis therapy (Osberg et al. 1982).