Uremic Encephalopathy Pathophysiology, symptoms & Management

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Uremic Encephalopathy

Uremic encephalopathy is a brain disease that develops in patients of acute or chronic renal failure due to uremia, drug toxicity, electrolyte imbalance, thiamine deficiency, transplant rejection, or infections. When the glomerular filtration rate falls below 15 ML/min in chronic kidney disease, it may also cause this organic brain disease.

UREMIA is an accumulation of waste products in the blood when kidneys are unable to excrete out the waste products from the body. And generally, ENCEPHALOPATHY presents with a symptom progressing from mild sensorial clouding to delirium and coma.
Symptoms of combined uremic encephalopathy vary from patient to patient depending on the severity of the renal failure.

Symptoms get worsen in the case of acute Renal failure. Prompt diagnosis of this encephalopathy is essential before the initiation of dialysis.

What Is The Pathophysiology Of The Uremic Encephalopathy?

The pathophysiology of uremic encephalopathy is still not known but many factors have been discovered that are involved in this brain disease. It is a complicated disease that have multifactorial process, Not a single can factor cause it. Oxidative stress, Hormonal disturbances, accumulation of waste metabolites,

disturbance of the intermediary metabolism, electrolytes imbalance, and imbalance in the excitatory and inhibitory neurotransmitters have been notified as contributing factors.
Most of the neurological complications of uremia such as uremic encephalopathy fail to respond to dialysis, despite continuous therapy. This neurological complication can aggravate by dialysis or renal transplantation.

Therefore, it is studied that antioxidants therapy should be used as an adjuvant therapy for the treatment of the neurological complications of uremia such as uremic encephalopathy.

What Are The Causes Of Uremic Encephalopathy?

Uremia occurs when your kidneys are irreversibly damaged to a greater extent such as in acute and chronic kidney diseases. It happens when your kidneys are unable to filter the waste products from your body and excrete it out through the urine. These waste metabolites stay in your bloodstream for a prolonged time and can cause serious life-threatening conditions. Patients having diabetes mellitus, hypertension or positive family history are more susceptible to have this uremic disease.

Causes of chronic kidney disease that may aggravate it, include

  • Hypertension
  • Diabetes mellitus (both type 1 & 2)
  • polycystic kidney disease
  • Glomerulitis ( inflammation of the glomeruli of the kidneys)
  • Recurrent kidneys infection
  • Kidney stones that may cause obstruction at any site of the urinary tract
  • Prostate enlarged
  • Cancers
  • Patient having high uric acid in blood

Symptoms of Uremic Encephalopathy

The manifestation of this disease causes some symptoms that may vary from patient to patient depending on their kidneys function.

When nitrogen and other waste products begin to accumulate in your blood, you may have

  • Nausea
  • Loss of appetite
  • Bizarre behavior
  • Loss of taste for some foods
  • Disorientation
  • Itchy
  • Fatigue or lethargic
  • Emotional viability
  • Lose weight
  • Confusions
  • Have trouble concentrating
  • Vomiting
  • Decrease cognitive functions
  • Feeling pain or numbness in your legs or feet(caused by damage to your nerves)

If uremia not treated yet, it can leads to further serious symptoms such as

  • Brain damage
  • High blood pressure
  • Anemia
  • Heart diseases
  • Stupor, coma

How It Can Be Managed?

When your kidneys are irreversibly damaged and you hAve developed uremia, you are left with limited options of treatment. Dialysis is the main treatment option after the uremia because medication will not cause any benefits, but may worsen it. The two best treatment options for uremic encephalopathy are

    1. Dialysis
    2. Kidney transplant

1- Dialysis

Dialysis is an artificial removal of nitrogenous wastes, extra fluids, and toxins from your bloodstream instead of by your kidneys. There are three main types of dialysis. The commonly used two types are:

Hemodialysis:

A dialyser machine is used to remove the harmful wastes from your body through the blood.

Peritoneal dialysis:

A catheter (small tube) is inserted into your abdomen. Dialysis fluid is entered in your abdomen through this catheter. This fluid absorbs all the waste and extra fluid from your body. Eventually, the fluid will remove the wastes from your body when it drains out. It repeats two to three times.

2- kidney Transplant

A kidney transplant is another treatment option if you reach end-stage renal disease. A kidney transplant is a healthy kidney is taken from a living or deceased donor and placed into your body. Antirejection medication is given you alongside the renal transplantation for a long time to prevent your body from rejecting the donor kidney by your immune system.

How Uremic Encephalopathy Can Be Prevented?

If you have chronic kidney disease then you must have your regular dialysis treatment to prevent these brain-related complications. Regular dialysis prevents the accumulation of waste products in your blood and ultimately prevent the uremia.

A patient having kidney disease should always avoid eating anything which is high in sodium, phosphorus, and potassium. They should have a proper dietary plan with the consultation of his doctor.

Daily walk or exercise should recommend to all the patients having kidney disease.
If the patient is diabetic, ask the patient to control their diabetes.

If the patient is hypertensive, tell them to control their blood pressure within the range and avoid the salt in your diet.

Quit smoking, if you are.

CONCLUSION

Uremic encephalopathy is a serious and life-threatening complication of acute and chronic kidney disease in which brain cells receive that blood which has high waste products and extra fluids. Once you have developed this complication, your kidneys are irreversibly damaged and only dialysis and renal transplantation options are left behind to prevent further damage.

You can prevent this complication by taking proper preventive measures such as have regular dialysis treatment, control your blood pressure, maintain your blood sugar, have healthy food, and do walk daily for at least 30 minutes.