Nephrogenic encephalopathy is a dysfunction of the central nervous system. The disease does not have any uniform symptoms, since the symptoms differ greatly in individual cases. Nephrogenic encephalopathy results as a consequence of decompensated renal insufficiency or uraemia.
What is Nephrogenic Encephalopathy?
In some cases, nephrogenic encephalopathy is also referred to by the synonymous terms uraemic encephalopathy or renal encephalopathy. The main symptom of nephrogenic encephalopathy at the onset of the disease is intermittent cerebral edema. This edema causes typical intracranial pressure signs to appear, for example pain in the head, vomiting and so-called papilledemas. See phonejust for Capsular Contracture Meaning.
In some cases, nephrogenic encephalopathy causes other symptoms, such as so-called high-pressure angiopathies. As a result, some patients experience perivascular necrosis and so-called mass bleeding. Foci of demyelination and necrosis of ganglion cells are also possible. These symptoms are identified during histological analysis.
Causes
To date, the exact factors and mechanisms involved in the development of nephrogenic encephalopathy have not yet been conclusively researched. In principle, most assumptions assume that urinary substances are retained in the patient’s blood. This results in a disruption in the functioning of the brain as a result of various processes.
After some time, the urinary substances develop a neurotoxic effect, which primarily affects the central nervous system. The main cause of nephrogenic encephalopathy is therefore that certain substances accumulate in the blood. These are, for example, creatinine, uric acid and other substances that impair the acid-base balance. An increased concentration of urea is particularly relevant here.
In addition, the electrolyte metabolism is negatively affected, as a result of which hypercalcemia usually develops. As the corresponding urinary-associated substances build up in the person’s blood, the tissues of the nerves are damaged. As a result, the typical symptoms of nephrogenic encephalopathy develop. Associations with diseases such as diabetes mellitus and high blood pressure were also observed.
Symptoms, Ailments & Signs
The cardinal symptoms of nephrogenic encephalopathy focus on neurological deficits. Depending on the individual case, the symptoms develop over a shorter or longer period of time. In many cases of illness, the symptoms are first noticed by other people and only later by the patients themselves.
Neurological symptoms often occur with nephrogenic encephalopathy. For example, dysarthria, hyperreflexia, tremor and myoclonus are possible. In addition, some patients experience symptoms such as cerebral spasms. Very rarely, exogenous psychoses develop in people suffering from nephrogenic encephalopathy. These result primarily from the uraemia that accompanies the disease.
The characteristic symptoms of nephrogenic encephalopathy are irritation symptoms of a psychomotor nature, difficulty falling asleep and staying asleep, and a general feeling of restlessness. In addition, many affected patients suffer from affect lability. The general neurological symptoms of nephrogenic encephalopathy are primarily expressed in an increased need for sleep and disturbances in the sense of direction and concentration.
The people show a general slowdown, which relates to both thinking and movement processes. Sometimes a so-called stupor develops. The characteristic symptoms of nephrogenic encephalopathy are primarily caused by the effects of kidney weakness. The typical symptoms of nephrogenic encephalopathy occur due to the effect on the digestive tract as well as the cardiovascular system and the blood.
Diagnosis & course of disease
A diagnosis of nephrogenic encephalopathy often takes a long time, since the symptoms of the disease are relatively unspecific and indicate numerous other diseases. A narrowing down based on the symptoms is therefore often only possible to a limited extent. In addition, the patients themselves often experience little or no symptoms for a long time.
It is usually relatives or other close people who draw attention to the abnormalities. This adds the factor of the lack of insight into the disease, which often delays a diagnosis. People with suspected nephrogenic encephalopathy first confide in their general practitioner, who makes a referral to an appropriate specialist.
When evaluating the medical history in the first part of the diagnosis, a possibly existing kidney weakness is of great importance. Because it may provide the decisive indication of the possibility of nephrogenic encephalopathy. During the clinical examination, the treating specialist usually uses several methods of diagnostic technology.
Blood analyzes by laboratory tests are important. For example, an increased concentration of parathyroid hormone and hypercalcemia are detected. An EEG examination is also used in the majority of cases to diagnose nephrogenic encephalopathy. In some cases, imaging methods show evidence of cerebral atrophy.
Complications
Nephrogenic encephalopathy is already a complication of renal failure. It occurs when substances from the urine build up in the blood. The disorder initially manifests itself in the form of non-specific neurological symptoms that can also be assigned to other diseases. The neurological deficits range from difficulty concentrating to coma.
As already mentioned, the main feature of nephrogenic encephalopathy is cerebral edema. With the help of dialysis (blood washing), the symptoms can initially be suppressed again. However, the high intracranial pressure sometimes causes mass bleeding and vascular necrosis. In extreme cases, these complications can lead to death or permanent brain damage.
If the treatment takes place in time, at least a partial resolution of the symptoms is possible. Inadequate treatment of decompensated renal insufficiency, i.e. incomplete removal of the urinary substances from the blood, leads to chronic damage to the central nervous system. These substances have a neurotoxic effect and destroy the nerve cells, which can then no longer reproduce.
As a result, permanent dementia can develop, which is associated with affect lability, disorientation and forgetfulness. Cerebral seizures are also observed as complications of nephrogenic encephalopathy. Similar to epileptic seizures, these manifest themselves in sudden unconsciousness and muscle spasms all over the body. Occasionally, an involuntary bite of the tongue is possible. In rare cases, the urinary substances in the blood can also trigger a psychosis.
When should you go to the doctor?
When people exhibit disturbances in general functioning, there is cause for concern. Interruptions in speech, changes in language understanding and losses in mental performance must be observed. If they persist for several days or continue to increase, a doctor is needed.
An abnormality in the motor function, disturbances in the general movement sequences and an increased risk of accidents and falls must be clarified by a doctor. If a tremor occurs, contact a doctor or an emergency service immediately. In the case of muscle weakness, interruptions in the usual processes of the musculoskeletal system and pain, it is necessary to clarify the cause.
Disturbed sleep or the inability to settle down are characteristic of the condition. In most cases, the person affected suffers from difficulty falling asleep, general restlessness and restlessness. If headaches occur, changes in behavior are noticed or if the person concerned suffers from an inner weakness, he needs help. Mood swings and an aggressive appearance should be discussed with a doctor.
If attention and orientation deficits are noticed, if concentration is impaired or if everyday obligations can no longer be fulfilled, a doctor’s visit is necessary. Disorders of the kidney function, changes in weight or the complexion are further indications of a health impairment. There is a need for action, since in severe cases and untreated there is a risk of organ failure.
Treatment & Therapy
The most important measure in therapy for nephrogenic encephalopathy is dialysis. In this way, the superfluous urinary substances in the blood are removed. Cleansing the blood of urea has top priority here. This prevents further impairment of the nerve tissue by the neurotoxic substances. Successful treatment of nephrogenic encephalopathy results in some symptoms resolving.
Outlook & Forecast
The earlier treatment for nephrogenic encephalopathy begins, the better the prognosis for patients. It is also important for a good prognosis to reduce kidney exposure to nephrotoxic drugs. The typical neurological deficits of the patients can range from slight concentration disorders to a life-threatening coma, since the main characteristic of the disease is cerebral edema. With the help of blood washing, also called dialysis, the symptoms can initially be suppressed, but the high intracranial pressure that occurs often causes vascular necrosis and mass bleeding in those affected. In some cases, such complications lead to death or permanent brain damage in the affected patient.
However, if the therapy takes place in good time, at least a partial remission of the symptoms that occur is possible. However, inadequate therapy can lead to chronic damage to the central nervous system. As a result, dementia can develop. Cerebral seizures are also often observed as complications in the course of the disease.
These manifest themselves with sudden muscle cramps and loss of consciousness. In addition, a chronic course of the disease is to be expected. There is a continuous deterioration in the general condition of those affected. There is also the risk of patients falling into a coma. If the patient wakes up from this coma again, very severe health impairments should be expected.
Prevention
Prevention of nephrogenic encephalopathy is not possible in every individual case. In principle, the appropriate therapy of an existing kidney weakness supports the prevention.
Aftercare
After successful treatment, it is important to train independence and mobility. Various treatment options are available for this. These can either be controlled in a rehabilitation measure or carried out independently at home. Doctors and physiotherapists specify the exercises and adapt them individually depending on the progress.
Depending on the severity of the illness, it is also possible for an occupational therapist to be used. An occupational therapist helps to cope with the everyday activities that are necessary. Often something new has to be learned. In most cases, a combination of previous supervised rehabilitation and later independence makes sense.
Yoga and special massage and meditation techniques help to cope with pain. An intact circle of family and friends is also of great importance here. The social environment supports further stabilization, at least psychologically. Regular monitoring of blood and urine values is also very important for follow-up care.
This will initially take place at very short intervals, later larger control intervals are likely. The control must check the urine production of the kidneys to determine whether the minimum amount of urine is produced per second to ensure functionality. The glomerular filtration rate is used here. If the blood falls below a specified value, dialysis (blood washing) is required.
You can do that yourself
Since the entire musculoskeletal system is usually affected in nephrogenic encephalopathy, the goal of therapy is to maintain mobility and independence. In addition to medical measures, other alternative therapy methods can be used, which should be carried out independently at home.
Doctors, physiotherapists or ergotherapists provide instructions for exercises that demand and promote the mobility of the patient. These should be individually adapted to the status of the disease and continuously updated. Regularity in the implementation of the exercises is also important, as this is the only way to achieve the desired success of maintaining performance. Massage techniques can also be learned to treat hardening of the skin, which the patients can then incorporate into their everyday lives and use independently.
In addition to a positive influence on the affected connective tissue, such measures also have positive effects on the psychological condition of the person concerned. Self-determined preoccupation with one’s own body can significantly increase one’s personal quality of life. Alternative therapy methods such as yoga and meditation can be ways to learn to deal with symptomatic pain.
Involving the social environment of the sick person is always an important measure. Maintaining an intact social network can give new strength to deal with the disease. Friends and relatives can provide support in the event of setbacks and point out new perspectives.
