| [ Summary ] |
Central nervous system (CNS) damage in patients with chronic renal failure (CRF) develops various clinical manifestations. These include acute symptoms such as loss of consciousness, and convulsions, as well as chronic symptoms such as the cognitive dysfunction often seen in chronic dialysis patients. Uremic encephalopathy, a main cause of acute CNS damage in CRF, is a form of metabolic encephalopathy which results from an accumulation of uremic toxins and is promptly resolved by dialysis therapy. It is important that initial dialyses should be minimal in order to prevent dialysis disequilibrium syndrome in the treatment of uremic encephalopathy. This condition should be differentiated from many other causes of acute CNS damage such as cerebrovascular disease, hypoglycemia, hypoxic brain injury, hepatic encephalopathy, or drug intoxication. Recently, it has been reported that the prevalence of high-order brain function impairment, a representative symptom of chronic CNS damage, is considerably high in hemodialysis patients, although most seem to have normal brain functions. It has been emphasized in many reports that cognitive dysfunction, which may result from a variety of risk factors such as aging, hypertension and anemia, is of profound importance. It has also been demonstrated in many reports that cognitive dysfunction is improved following treatment of anemia with erythropoietin, increased dialysis dosage, or renal transplantation, however its pathogenesis remains to be elucidated. |