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.