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Uremic and Dialysis Encephalopathies

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Book cover Cerebral Energy Metabolism and Metabolic Encephalopathy

Abstract

In this chapter we first develop a definition by which the neurobehavioral syndrome, “uremic encephalopathy,” and its variant presentations may be recognized as they occur clinically in integrated, whole organisms and as they may be indexed—at least to some extent—by objective and quantitative measurement techniques. These latter indices provide an essential linking “bridge of relevance” between the syndrome, itself the essential clinical reality, and the physiological and chemical data that are derived from probes into lower levels of biological organization at which the clinical, whole-organism identifiers of “uremic encephalopathy” are necessarily lost. Following this is a review of the available information concerning abnormal cerebral chemistry and metabolism in experimental animals and in human subjects with renal failure, with an attempt to validate the relevance of such observations to the defining clinical syndrome.

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References

  • Addison, T., 1839, On the disorders of the brain connected with diseased kidneys, Guy’s Hosp. Rep. 4: 1–7.

    Google Scholar 

  • Alfrey, A. C., Mishell, J. M., Burks, J., Contiguglia, R. H., Lewin, E., and Holmes, J. H., 1972, Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis, Trans. ASAIO 18: 257–261.

    Article  CAS  Google Scholar 

  • Alfrey, A. C., LeGendre, G. R., Kaehney, W. D., 1976, The dialysis encephalopathy syndrome: Possible aluminum intoxication, N. Engl. J. Med. 294: 184–188.

    Article  PubMed  CAS  Google Scholar 

  • Allen, E. M., Malamed, D., and Singer, F. R., 1970, Electroencephalographic abnormalities in hypercalcemia, Neurology 20: 15–22.

    PubMed  CAS  Google Scholar 

  • Arieff, A. I., 1981, Neurological complications of uremia, in: The Kidney, 2nd ed. (B. M. Brenner and F. C. Rector, Jr., eds.), W. B. Saunders, Philadelphia, pp. 2306–2343.

    Google Scholar 

  • Arieff, A. I., and Massry, S. G., 1974, Calcium metabolism of brain in acute renal failure: Effects of uremia, hemodialysis and parathyroid hormone, J. Clin. Invest. 53: 387–392.

    Article  CAS  Google Scholar 

  • Arieff, A. I., Massry, S. G., Barrientos, A.. and Kleeman, C. R., 1973, Brain water and electrolyte metabolism in uremia: Effects of slow and rapid hemodialysis, Kidney Int. 4: 177–187.

    CAS  Google Scholar 

  • Arieff, A. I., Cooper, J. D., Armstrong, D., and Lazarowitz, V. C., 1979, Dementia, renal failure and brain aluminum, Ann. Intern. Med. 90: 741–747.

    CAS  Google Scholar 

  • Arieff, A. I., Guisado, R., Massry, S. G., and Lazarowitz, V. C., 1976, Central nervous system pH in uremia, hemodialysis and parathyroid hormone, J. Clin. Invest. 58: 306–311.

    Article  CAS  Google Scholar 

  • Bergstrom, J., and Fürst, P., 1978, Uraemic toxins, in: Replacement of Renal Function by Dialysis (W. Drukker, F. M. Parsons. and J. F. Maher, eds.), Martinus Nijhoff, The Hague, pp. 334–368.

    Google Scholar 

  • Bourne, J. R., Miezin, F. M., Ward, J. W., and Teschan, P. E., 1975a, Computer quantification of electroencephalographic data recorded from renal patients, Comput. Biomed. Res. 8: 461–473.

    CAS  Google Scholar 

  • Bourne, J. R., Ward, J. W., Teschan, P. E., Musso, M., Johnston, H. B., Jr., and Ginn, H. E., 1975b, Quantitative assessment of the electroencephalogram in renal disease, Electroencephogr. Clin. Neurophysiol. 39: 377–388.

    CAS  Google Scholar 

  • Bowling, P. S., and Bourne, J. R., 1978, Discriminant analysis of electroencephalograms recorded from renal patients, IEEE Trans. Bio-Med. Eng. 25: 12–17.

    Article  CAS  Google Scholar 

  • Bright, R., 1836, Cases in observations illustrative of renal disease accompanied by the secretion of albuminous urine. Guy’s Hosp. Rep. 1: 338–379.

    Google Scholar 

  • Cogan, M., Covey, C., Arieff, A. I., Wisniewski, A., Clark, O., Lazarowitz, V. C., and Leach, W., 1978, Central nervous system manifestations of hyperparathyroidism, Am. J. Med. 65: 963–970.

    Article  PubMed  CAS  Google Scholar 

  • Cooper, J. D., Lazarowitz, V. C., and Arieff, A. I., 1978, Neurodiagnostic abnormalities in patients with acute renal failure: Evidence for neurotoxicity of parathyroid hormone, J. Clin. Invest. 61: 1448–1455.

    Article  CAS  Google Scholar 

  • Dewberry, F. L., McKinney, T. D., and Stone, W. J., 1980, Report of fourteen cases and review of the literature, ASAIO J. 3: 102–108.

    Google Scholar 

  • Edwards, A. E., Kopple, J. E., Miller, J. M., Fields, L. G., and Der, D. F., 1977, Time perception and hemodialysis, Nephron 19: 140–145.

    Article  PubMed  CAS  Google Scholar 

  • Engel, G. L., and Romano, J., 1944, Delirium: II. Reversibility of the EEG with experimental procedures, Arch. Neurol. Psychiatry 51: 378–392.

    Google Scholar 

  • Engel, G. L., Romano, J., Ferris, E. G., Jr., Webb, J., and Stevens, C. D., 1944, A simple method of determining frequency spectrums in the electroencephalogram, Arch. Neural. Psychiatry 51: 134–146.

    Google Scholar 

  • Essman, W. B., 1962, Effects of an experimentally induced acute renal failure on a learned maze response in rats, J. Gen. Psycho]. 67: 51–56.

    CAS  Google Scholar 

  • Essman, W. B., 1965, Behavioral bioassay for experimentally induced uremic endotoxemia in rats, Percept. Mot. Skills 20: 115–120.

    Article  CAS  Google Scholar 

  • Fishman, R. A., 1970, Permeability changes in experimental uremic encephalopathy, Arch. Intern. Med. 126: 835–837.

    CAS  Google Scholar 

  • Friedman, E. A., 1978, Oral sorbents, in: Replacement of Renal Function by Dialysis ( W. Drukker, F. M. Parsons, and J. F. Maher, eds.), Martinus Nijhoff, The Hague, pp. 232–243.

    Google Scholar 

  • Glaser, G. H., 1960, Metabolic encephalopathy in hepatic, renal and pulmonary disorders, Postgrad. Med. 27: 611–619.

    CAS  Google Scholar 

  • Glaser, G. H. (ed.), 1976, The EEG in renal insufficiency, in: Handbook of Electroencephalography and Clinical Neurophysiology, Volume 15 ( A. Redmond, ed.), Elsevier Scientific Publishing Company, Amsterdam, pp. 51–69.

    Google Scholar 

  • Goldstein, D. A., Feinstein, E. I., Chui, L. A., Pattabhiraman, R., and Massry, S. G., 1980, The relationship between the abnormalities in EEG and blood levels of parathyroid hormone in dialysis patients, J. Clin. Endocrinol. Metab. 51: 130–134.

    CAS  Google Scholar 

  • Guisado, R., Arieff, A. I., and Massry, S. G., 1975, Changes in the electroencephalogram in acute uremia: Effects of parathyroid hormone and brain electrolytes, J. Clin. Invest. 55: 738–745.

    Article  CAS  Google Scholar 

  • Hagstam, K. E., 1977, EEG frequency content related to chemical blood parameters in chronic uremia, Scand. J. Urol. Nephrol. 7 (suppl. 1): 1–33.

    Google Scholar 

  • Hamel, B., Bourne, J. R., Ward, J. W., and Teschan, P. E., 1978, Visually evoked cortical potentials in renal failure: Transient potentials, Electroencephalogr. Clin. Neurophysiol, 44: 606–616.

    CAS  Google Scholar 

  • Hayman, P. R., and Kooi, K. A., 1969, Visually evoked cortical responses in renal insufficiency, Univ. Mich. Med. Cent. J. 35: 177–179.

    Google Scholar 

  • Heath, H., Hodgson, S. F., and Kennedy, M. A., 1980, Primary hyperparathyroidism, N. Engl. J. Med. 302: 189–193.

    Google Scholar 

  • Hughes, J. R., 1980, Correlations between EEG and chemical changes in uremia, Electroencephalogr. Clin. Neurophysiol. 48: 583–594.

    CAS  Google Scholar 

  • Jacob, J. C., Gloor, P., Elwan, O. H., Dossetor, J. B., and Pateras, V. R., 1965, Electroencephalographic changes in chronic renal failure, Neurology 15: 419.

    PubMed  CAS  Google Scholar 

  • Kennedy, A. C., Linton, A. L., and Eaton, J. C., 1962, Urea levels in cerebrospinal fluid after hemodialysis, Lancet 1: 410–411.

    Article  PubMed  CAS  Google Scholar 

  • Kennedy, A. C., Luke, R. G., and Linton, A. L., 1964, Dialysis disequilibrium syndrome, in: Renal Failure ( S. Shaldon and G. C. Cook, eds.), Blackwell Scientific Publications, Oxford, United Kingdom, pp. 66–79.

    Google Scholar 

  • Kiley, J. E., 1981, Residual renal and dialyzer clearance, EEG slowing, and nerve conduction velocity, ASAIO J. 4: 1–8.

    Google Scholar 

  • Kiley, J. E., and Hines, 0., 1963, Electroencephalographic evaluation of uremia, in: Proceedings of the 2nd International Congress of Nephrology, Excerpta Medica Foundation, New York, pp. 745–747.

    Google Scholar 

  • Kiley, J. E., and Hines, O., 1975, Electroencephalographic evaluation of uremia, Arch. Intern. Med. 116: 67–73.

    Google Scholar 

  • Kiley, J. E., Millora, A. B., and Woodruff, M., 1970, The quantitative EEG in uremia, in: Proceedings, Workshop on Behavioral Bioassays in Uremia, Washington. D.C., DHEW Publication #(NIH)72–37, U.S. Printing Office #1744–0004, pp. 41–53.

    Google Scholar 

  • Kiley, J. E., Pratt, K. L., Gisser, D. G., and Schaffer, C. A., 1976a, Techniques of EEG frequency analysis for evaluation of uremic encephalopathy, Clin. Nephrol. 5: 279–285.

    CAS  Google Scholar 

  • Kiley, J. E., Woodruff, M. W., and Pratt, K. L., 1976b, Evaluation of encephalopathy by EEG frequency analysis in chronic dialysis patients, Clin. Nephrol. 5: 245–250.

    CAS  Google Scholar 

  • Klingler, M., 1974, EEG Observations in uremia (abstract), Electroencephalogr. Clin. Neurophysiol. 6: 519.

    Google Scholar 

  • Lewis, E. G., Dustman, R. E., and Beck, E. C., 1978, Visual and somatosensory evoked potential characteristics of patients undergoing hemodialysis and kidney transplantation, Electroencephalogr. Clin. Neurophysiol. 44: 223–231.

    CAS  Google Scholar 

  • Lishman, W. A., 1978, Organic Psychiatry, Blackwell Scientific Publications, London.

    Google Scholar 

  • Mahoney, C. A., and Arieff, A. I., 1983, Central and peripheral nervous system effects of chronic renal failure, Kidney Int. 24: 170–177.

    Article  PubMed  CAS  Google Scholar 

  • McDaniel, J. W., 1971, Metabolic and CNS correlates of cognitive dysfunction with renal failure, Psychophysiology 8: 704–713.

    Article  PubMed  CAS  Google Scholar 

  • Miller, J. H., Kopple, J. D., Edwards, A. E., Der, D. F., Fields, L. G., and Gardner P. W., 1974, Assessment of central nervous system function in uremia, Proc. Clin. Dial. Transplant. Forum 4: 156–159.

    PubMed  Google Scholar 

  • Murphy, G. P., and Sharp, J. C., 1964, Timed behavior in primates during various experimental uremic states, J. Surg. Res. 4: 550–553.

    Article  PubMed  CAS  Google Scholar 

  • Raskin, N. H., and Fishman, R. A., 1976, Neurologic disorders in renal failure, N. Engl. J. Med. 294: 143–148.

    Article  PubMed  CAS  Google Scholar 

  • Rasmussen, H., and Goodman, D. B. P., 1977, Relationships between calcium and cyclic nucleotides in cell activation: Cellular calcium metabolism and calcium-mediated cellular processes, Physiol. Rev. 57: 428–441.

    Google Scholar 

  • Richet, G., Lopez de Novales, E., and Verroust, P., 1970, Neurological episodes in chronic renal failure, Br. Med. J. 2: 394–395.

    Article  PubMed  CAS  Google Scholar 

  • Romano, J., and Engel, G. L., 1944, Delirium: I. Electroencephalographic data, Arch. Neurol. Psychiatry 51: 356–377.

    Google Scholar 

  • Rotundo, A., Nevins, T. E., Lipton, M., Lockman, L. A., Mauer, S. M., and Michael, A. F., 1982, Progressive encephalopathy in children with chronic renal insufficiency in infancy, Kidney Int. 21: 486–491.

    CAS  Google Scholar 

  • Schreiner, G. E., 1959, Mental and personality changes in the uremic syndrome, Med. Ann. D.C. 28: 316–323.

    CAS  Google Scholar 

  • Schreiner, G. E., and Maher, J. F., 1961, Uremia, Biochemistry, Pathogenesis and Treatment, Charles C Thomas, Springfield, Illinois.

    Google Scholar 

  • Sharp, J. C., and Murphy, G. P., 1964, Conditioned avoidance behavior in primates during various experimental uremic states, Nephron 1: 172–179.

    Article  PubMed  CAS  Google Scholar 

  • Sharp, J. C., and Murphy, G. P., 1966, A behavioral bioassay method using material from a uremic patient, Percept. Mot. Skills 22: 127–133.

    Article  PubMed  CAS  Google Scholar 

  • Spehr, W., Sartorius, H., Berglund, K., Hjorth, B., Kablitz, C., Plog. V., Wiedemann, P. H., and Zapf, K., 1977, EEG and hemodialysis: A structural survey of EEG spectral analysis, Hjorth’s EEG descriptors, blood variables and psychological data, Electroencephalogr. Clin. Neurophysiol. 43: 787–797.

    CAS  Google Scholar 

  • Stone, W. J., 1983, Medical complications of end-stage renal disease, in: End Stage Renal Disease, An Integrated Approach ( W. J. Stone and P. L. Rabin, eds.), Academic Press, New York, pp. 57–83.

    Google Scholar 

  • Teschan, P. E., 1970a, On the pathogenesis of uremia, Am. J. Med. 48: 671–677.

    Article  CAS  Google Scholar 

  • Teschan, P. E., 1970b, Approaches to the study of uremic toxicity: An experimental model, in: Proceedings of the 4th International Congress of Nephrology Karger, Basel, pp. 242–247.

    Google Scholar 

  • Teschan, P. E., 1981, Measurement of neurobehavioral responses to renal failure, dialysis and transplantation, in: Psychonephrology I. Physiological Factors in Hemodialysis and Transplantation ( N. B. Levy, ed.), Plenum, New York, pp. 13–18.

    Google Scholar 

  • Teschan, P. E., 1983, The presentation of the patient with chronic renal failure, in: End Stage Renal Disease, An Integrated Approach ( W. J. Stone and P. L. Rabin, eds.), Academic Press, New York, pp. 31–56.

    Google Scholar 

  • Teschan, P. E., and Ginn, H. E., 1976, The nervous system, in: Clinical Aspects of Uremia and Dialysis ( S. G. Massry and A. L. Sellers, eds.), Charles C Thomas, Springfield, Illinois, pp. 333.

    Google Scholar 

  • Teschan, P. E., Murphy, G. P., and Sharp, J. C., 1964, Investigation of behavioral performance during urine reinfusion in the male primate, Am. J. Physiol. 206: 510–514.

    PubMed  CAS  Google Scholar 

  • Teschan, P. E., Carter, C. B., and Taub, E., 1970, Experimental studies of toxic factors in uremic encephalopathy, Arch. Intern. Med. 126: 838–840.

    CAS  Google Scholar 

  • Teschan, P. E., Ginn, H. E., Bourne, J. R., Ward, J. W., Hamel, B., Nunnally, J. C., Musso, M., and Vaughn, W. K., 1979, Quantitative indices of clinical uremia, Kidney Int. 15:676–697. Tyler, H. R., 1968, Nuerologic disorders in renal failure, Am. J. Med. 44: 734–748.

    Google Scholar 

  • Tyler, H. R., 1970, Neurologic disorders seen in the uremic patient, Arch. Intern. Med. 126: 781–786.

    Article  PubMed  CAS  Google Scholar 

  • van den Noort, S., Eckel, R. E., Brine, K., and Hrdlicka, J. T., 1968, Brain metabolism in uremic and adenosine-infused rats, J. Clin. Invest. 47: 2133–2142.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, 37232, USA

    Paul E. Teschan

  2. Nephrology Section, Department of Medicine, University of California at San Francisco, San Francisco, California, 94143, USA

    Allen I. Arieff

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  1. Paul E. Teschan
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  2. Allen I. Arieff
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Editors and Affiliations

  1. Department of Neurobiology and Anatomy, University of Texas Medical School at Houston, 77025, Houston, Texas, USA

    David W. McCandless

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© 1985 Plenum Press, New York

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Teschan, P.E., Arieff, A.I. (1985). Uremic and Dialysis Encephalopathies. In: McCandless, D.W. (eds) Cerebral Energy Metabolism and Metabolic Encephalopathy. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-1209-3_11

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  • DOI: https://doi.org/10.1007/978-1-4684-1209-3_11

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4684-1211-6

  • Online ISBN: 978-1-4684-1209-3

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