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Uremic encephalopathy
Other Resources UpToDate PubMed

Uremic encephalopathy

Contributors: Andrea Wasilewski MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Uremic encephalopathy is defined as alterations in cognitive function in a patient with acute kidney injury or chronic kidney failure without other underlying conditions that would account for mental status change. Early features of uremic encephalopathy include lethargy, irritability, hallucinations, and disorientation. On physical examination, patients may have mild diffuse weakness with slowing of movements, tremor, myoclonus, and asterixis. Urea crystals (uremic frost) may appear on the skin. Patients with severe acute renal failure and acute uremia may present with coma or seizures.

Treatment includes hemodialysis, although there may be a 1- to 2-day lag time before significant improvements in mental status are appreciated.

If a patient fails to improve with hemodialysis, alternate causes of acute encephalopathy should be sought.


N25.9 – Disorder resulting from impaired renal tubular function, unspecified

35145002 – Uremic encephalopathy

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Differential Diagnosis & Pitfalls

  • Nonconvulsive Status epilepticus
  • Seizure
  • Anti-N-methyl-D-aspartate receptor antibody syndrome
  • Anticholinergic syndrome
  • Creutzfeldt-Jakob disease
  • Human immunodeficiency virus disease encephalopathy
  • Progressive multifocal leukoencephalopathy
  • Herpes simplex virus encephalitis
  • Hepatic encephalopathy
  • Hashimoto encephalopathy
  • Drug intoxication (many)

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Last Reviewed:06/18/2018
Last Updated:11/13/2018
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Uremic encephalopathy
A medical illustration showing key findings of Uremic encephalopathy : Fatigue, Vomiting, Asterixis, Creatinine elevated, Delirium, Irritability, Neuropathy peripheral, Anorexia, BUN elevated, Lethargy, Myoclonus, Hallucination
Copyright © 2024 VisualDx®. All rights reserved.