Diagnosis and Treatment of Uremic Encephalopathy

Uremic encephalopathy refers to a spectrum of neurological and psychiatric symptoms caused by central nervous system damage due to uremia. Key manifestations include:

Clinical Features

• Psychiatric symptoms: Fatigue, poor concentration, apathy or irritability, memory loss, slowed cognition; severe cases may present with confusion, hallucinations (auditory/visual), or delusions.
• Consciousness impairment: Drowsiness to coma.
• Neurological signs: Seizures, involuntary movements, hemiparesis, aphasia, or ataxia.

Diagnosis:
Chronic kidney disease patients without prior neuropsychiatric history developing these symptoms during renal failure likely have uremic encephalopathy.

Differential Diagnosis:

• Hypertensive encephalopathy
• Dialysis disequilibrium syndrome
• Hepatic encephalopathy
• Neurological complications of other systemic diseases

Treatment Strategies

1. Dialysis Therapy
   • Adequate dialysis reduces toxin accumulation and prevents encephalopathy.
2. Kidney Transplantation
   • The definitive cure for uremia and its complications.
3. Supportive Care
   • Correct malnutrition, electrolyte imbalances, dehydration, acidosis, and hypertension to mitigate symptoms.
4. Medication Safety
   • Minimize nephrotoxic drugs to avoid exacerbating CNS effects.
5. Symptomatic Management
   • Sedatives for seizures or severe agitation.