Uremic encephalopathy

Case contributed by Abiola Ayodele


Acute confusional state, seizures, and eventual coma in a patient being managed for acute kidney injury.

Patient Data

Age: 40 years
Gender: Female

Confluent bilateral hypodensities involving the basal ganglia. Effacement of the anterior horn of the right lateral ventricle is noted.

Biochemistry report

  • Urea                24.8 mm/l
  • Creatinine       836umol/l
  • eGFR                5 ml/min
  • Bicarbonates 15mmol/l
  • Sodium           135mmol/l
  • Potassium       3.5mmol/l
  • Chloride          102mmol/l

Case Discussion

Uremic encephalopathy is defined as cerebral dysfunction due to the accumulation of toxins in patients with untreated or inadequately treated acute or chronic kidney disease1. It usually develops when the estimated glomerular filtration rate (eGFR) decreases and stays below 15 ml/min2. Uremic encephalopathy presents as a complex syndrome that varies in its presentation from mild sensory clouding to delirium, seizures, and coma. CT typically presents as confluent bilateral hypodensity involving the basal ganglia, thalamus, and midbrain.

Differential diagnoses of this appearance include other toxic encephalopathies such as acute liver failure, hepatic encephalopathy, drug overdose, and toxic exposures.

The patient underwent serial dialysis with significant improvement.

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