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Nervous System Complications in Uremia

Cosmo L. Fraser, MD; and Allen I. Arieff, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by the Research Service of the Veterans Administration Medical Center, San Francisco, California, and by grant AM 28127 from the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases, Department of Health and Human Services, Public Health Service. Dr. Cosmo L. Fraser is a Research Associate of the Veterans Administration.

Requests for Reprints: Allen I. Arieff, MD, Veterans Administration Medical Center, III, 4150 Clement Street, San Francisco, CA 94121.

Current Author Addresses: Drs. Fraser and Arieff, Veterans Administration Medical Center, III, 4150 Clement Street, San Francisco, CA 94121.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(2):143-153. doi:10.7326/0003-4819-109-2-143
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In patients with end-stage renal disease, nervous system dysfunction remains a major cause of disability. Patients with chronic renal failure who have not yet received dialysis may have symptoms ranging from mild sensorial clouding to delirium and coma. Dialysis itself is associated with at least three distinct disorders of the central nervous system, including the dialysis disequilibrium syndrome, dialysis dementia, and progressive intellectual dysfunction. Peripheral neuropathy is also a major cause of disability in uremic patients. Aluminum probably contributes to the pathogenesis of dialysis dementia. Parathyroid hormone, the levels of which are elevated in patients with renal failure, also may be a uremic neurotoxin. Biochemically, brain calcium levels are elevated in renal failure, possibly because of the action of parathyroid hormone. Studies on synaptosomes have also shown that parathyroid hormone can affect calcium transport in the brain. Intellectual dysfunction, dialysis dementia, uremic neuropathy, and the dialysis disequilibrium syndrome can be diagnosed when the characteristic clinical findings are present and other causes of nervous system dysfunction have been excluded.





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