ReviewNeurological complications in renal failure: a review
Introduction
Patients with renal failure often have signs and symptoms related to fluid and electrolyte disturbances, anemia, malnutrition, bone disease and gastrointestinal problems. Vascular and neurologic impairment in particular remain an important source of morbidity and mortality in this vulnerable patient population.
In this paper, disease related and treatment related neurological complications in renal failure will be reviewed. With the introduction of dialysis and renal transplantation, the spectrum of neurological complications changed. The incidence and severity of uremic encephalopathy, atherosclerosis, neuropathy and myopathy have declined but many patients fail to fully respond to dialytic therapy.
Moreover, dialytic therapy or kidney transplantation may even induce neurological complications. Dialysis dementia, dialysis dysequilibrium syndrome, hypertensive encephalopathy and cerebrovascular accident due to ultrafiltration-related arterial hypotension can occur as a direct consequence of dialysis. Furthermore, dialysis is associated with aggravation of atherosclerosis and can contribute to the development of Wernicke's encephalopathy, hemorrhagic stroke, subdural hematoma, osmotic myelinolysis, opportunistic infections, intracranial hypertension and neuropathy. Patients with renal failure may benefit from kidney transplantation, but the use of immunosuppressive drugs can cause encephalopathy, movement disorders, opportunistic infections, neoplasms, myopathy and progression of atherosclerosis. Renal transplantation itself can give rise to acute femoral neuropathy, rejection encephalopathy and neuropathy in graft versus host disease (Table 1). In what follows, we will address both central and peripheral nervous system complications in patients with renal failure.
Section snippets
Encephalopathy
In patients with renal failure, encephalopathy is a common problem that may be caused by uremia, thiamine deficiency, dialysis, transplant rejection, hypertension, fluid and electrolyte disturbances or drug toxicity [1] (Table 2). In general, encephalopathy presents with a symptom complex progressing from mild sensorial clouding to delirium and coma. It is often associated with headache, visual abnormalities, tremor, asterixis, multifocal myoclonus, chorea and seizures. These signs fluctuate
Mononeuropathy
In uremia, susceptibility of the peripheral nerves to compression and local ischemia is increased. In practice especially the ulnar, median and femoral nerves are affected (Table 3).
Damage to the ulnar nerve can occur by uremic tumoral calcinosis at the wrist, in Guyon's canal [172]. Depending on the site of compression in the canal, this may cause purely motor dysfunction with paresis of intrinsic hand muscles, sensory loss to the hypothenar eminence, the small finger and the lateral part of
Conclusion
Neurological complications whether due to the uremic state or its treatment, contribute largely to the morbidity and mortality in patients with renal failure. Despite continuous therapeutic progress, most neurological complications of uremia fail to fully respond to dialysis and many are elicited or aggravated by dialysis or renal transplantation.
In order to assure optimal care for patients with renal failure, both neurologists and nephrologists should be familiar with the neurologic
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