Abstract
Progressive advances in dialysis treatment have altered clinical manifestations of renal failure. This has been particularly striking in the area of neurology, resulting in the definition of new syndromes as a consequence of both increased longevity and the complications of dialysis treatment.
The current situation is reviewed and the results of a study of neurological complications in renal failure are described.
Full-fledged clinical uremic encephalopathy and neuropathy have become scarce but they are often experienced subclinically. About 50% of dialysis outpatients have indicated subnormal and predementia patterns in electroencephalograms. Postmortem neuropathological studies of dialysis patients indicated a decrease in brain edema but an increase in brain atrophy, micro-softening, microbleeding, degeneration, and demyelination such as central pontine myelinolysis with prolonged dialysis. Many factors, for example, abnormal metabolism, renal failure, abnormal cerebral circulation, trace elements, various deficiencies and so on are attributed to cerebral dysfunction.
Death due to cerebro-vascular disease is increasing annually among long-term dialysis patients. It is necessary to prevent accelerated atherosclerosis and maintain cerebral circulation through control of optimum blood pressure.
Subdural hematoma in a well-defined complication which CT scanning easily confirms. Today, the disequilibrium syndrome in more often observed in treatment involving the use of high dialysance dialyzers. However, hemofiltration is available for the prevention of the disequilibrium syndrome. The accumulation in the body of trace elements in the dialysate permeating the dialysis membrane is a major problem. Aluminium poisoning especially is reported as one of the main causes of dialysis encephalopathy, but hyperparathyroidism and phosphate depletion also are reported to be responsible. The appearance of any new neurological symptom in a dialysis patient calls for a review of all drug terapy. Both dialysis therapy and rehabilitation are necessary for patients with atrophy of disuse and dementia.
Generally, neurological symptoms are slowly progress and therefore may be overlooked. Accurate observations of neurological symptoms and neurological examinations may uncover answers regarding pathogenesis and therapy in neurological complications.
