Neurologic Complications of Renal Failure

Abstract

T HE ASSOCIATION between abnormal renal function and central nervous system disease was recognized nearly 40 years ago . Seizures and coma were frequent complications of acute uremia , whereas peripheral neuropathy and encephalopathy, observed in progressive uremia, were terminal events. Despite improvements in the medical management of end-stage renal failure, including dialysis and transplantation, patients manifest a variety of neurologic disorders . The acute cerebral changes associated with uremia may present as the dialysis disequilibrium syndrome or as subdural, intracerebral or intraspinal hemorrhage; these bleeding diatheses occur in up to 10% of hypertensive hemodialysis patients . Potential toxins accumulating in uremia are numerous (see article by Powell et aI, this issue). To be considered a uremic toxin , the concentration of any putative compound should correlate better with some measurement of nerve or cerebral function than with a reduction in glomerular filtration rate. To date , this has not been convincingly demonstrated. The neurologic complications of arterial hypertension in children include convulsions in over 90 % of children with severe hypertension and facial palsy, blindness, paraplegia, and alterations in the level of consciousness.' Children may present with seizures as the first sign of hypertension. The prognosis for children having had a single episode of hypertensive encephalopathy is good, with no demonstrative neurologic deficit or focal abnormality on brain scan by computerized tomography.'