Olano Claudia G., Akram Sami M., Hashmi Muhammad F., Bhatt Harshil
Harbor UCLA Medical Center
University of Florida, Gainesville
Uremic encephalopathy is defined as cerebral dysfunction caused by the accumulation of toxins due to acute or chronic renal failure. This condition typically develops in patients with acute or chronic renal failure whose estimated glomerular filtration rate (eGFR) is below 15 mL/min. The clinical presentation of uremic encephalopathy is broad, varying from subtle to florid, and the clinical course is always progressive when left untreated. Uremic encephalopathy is at least partially reversible with the initiation of renal replacement therapy, making it a clear indication to start such treatment. The syndrome likely results from alterations in hormonal metabolism, retention of uremic solutes, changes in electrolyte and acid-base homeostasis, blood-brain barrier transport, changes in vascular reactivity, and inflammation. Diagnosis of uremic encephalopathy is challenging, as there are no specific clinical, laboratory, or imaging findings. The condition is often diagnosed retrospectively when symptoms improve after dialysis or kidney transplantation. If symptoms do not improve after clearing toxic solutes, other potential causes should be investigated.
尿毒症性脑病被定义为由急性或慢性肾衰竭导致的毒素蓄积所引起的脑功能障碍。这种情况通常发生在估算肾小球滤过率（eGFR）低于15 mL/分钟的急性或慢性肾衰竭患者中。尿毒症性脑病的临床表现广泛，从轻微到明显不等，若不治疗，临床病程总是呈进行性发展。随着肾脏替代治疗的开始，尿毒症性脑病至少部分是可逆的，这明确表明需要启动此类治疗。该综合征可能源于激素代谢改变、尿毒症溶质潴留、电解质和酸碱平衡变化、血脑屏障转运、血管反应性改变以及炎症。尿毒症性脑病的诊断具有挑战性，因为没有特异性的临床、实验室或影像学表现。当透析或肾移植后症状改善时，该疾病常通过回顾性诊断。如果清除毒性溶质后症状没有改善，则应调查其他潜在病因。
