A patient with end-stage renal disease may develop a metabolic encephalopathy related to retained toxins.


(1) end-stage renal disease with GFR less than 15 mL per min per 1.73 square meters

(2) onset of signs and symptoms compatible with encephalopathy

(3) improvement with dialysis

(4) exclusion of other causes of encephalopathy (drugs, stroke, hypoglycemia, electrolyte abnormalities, etc)


Findings may be more severe with a rapid decline ni renal function.


Clinical findings may include:

(1) nausea and vomiting

(2) anorexia

(3) altered mental status

(4) slowing of cognitive function

(5) disorientation

(6) psychological manifestations (emotional volatility, bizarre behavior, etc)

(7) nystagmus

(8) chorea

(9) papilledema

(10) hyperreflexia or clonus

(11) ataxia with altered gait

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