Abstract
Among patients with renal failure, nervous system dysfunction remains a major cause of disability. Depite the widespread use of dialysis therapy, such patients continue to manifest a variety of neurologic disorders [1]. Patients with chronic renal failure who have not yet received dialytic therapy may develop symptoms ranging from mild sensorial clouding to delirium and coma [2]. Even after the institution of adequate maintenance dialysis therapy, patients may continue to manifest more subtle nervous system dysfunction such as impaired mentation, generalized weakness, sexual dysfunction and peripheral neuropathy [3, 4].
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Fraser CL, Arieff AI (1988) Neurological complications of uremia. In: Schrier RW, Gottschalk CW (eds) Strauss and Welt: diseases of the kidney, 4th edn. Little & Brown, Boston, pp 3063–3092
Teschan PE, Arieff AI (1985) Uremic and dialysis encephalopathies. In: McCandless DW (ed) Cerebral energy metabolism and metabolic encephalopathy. Plenum Publishing, New York, pp 263–286
Fraser CL, Sarnacki P, Arieff AI (1985) Abnormal sodium transport in synaptosomes from brain of uremic rats. J Clin Invest 75:2014–2023
Said G, Boudier L, Selva J, Zingraff J, Drueke T (1983) Different patterns of uremic polyneuropathy: A clinicopathologic study. Neurology 33:567–574
Teschan PE, Ginn HE, Bourne JR, et al (1979) Quantitative indices of clinical uremia. Kidney Int 15:676–697
Arieff AI (1985) Effects of water, electrolyte and acid base disorders on the central nervous system. In: Arieff AI, DeFronzo RA (eds) Fluid, electrolyte and acid base disorders. Churchill Livingstone, New York, pp 969–1040
Chung HM, Kluge R, Schrier RW, Anderson RJ (1986) Postoperative hyponatremia: A prospective study. Arch Intern Med 146:333–336
Papadakis MA, Arieff AI (1988) Hyponatremia and hypernatremia in patients with liver disease. In: Epstein M (ed) The kidney in liver disease, 3rd edn. Williams & Wilkins, Baltimore, pp 73–88
Cooper JD, Lazarowitz VC, Arieff AI (1978) Neurodiagnostic abnormalities in patients with acute renal failure: Evidence for neurotoxicity of parathyroid hormone. J Clin Invest 61:1448–1455
Hughes JR (1980) Correlation between EEG and chemical changes in uremia. Electroenceph Clin Neurophysiol 48:583–594
Kiley JE, Woodruff MW, Pratt KL (1976) Evaluation of encephalopathy by EEG frequency analysis in chronic dialysis patients. Clin Neph 5:245–250
Ginsberg MD (1979) Delayed neurolgical deterioration following hypoxia. Adv Neurol 26:21–44
Souheaver GT, Ryan JJ, De Wolfe AS (1982) Neuropsychological patterns in uremia. J Clin Psychol 38:490–496
Fraser CL, Sarnacki P, Arieff AI (1985) Calcium transport abnormality in uremic rat brain synaptosomes. J Clin Invest 76:1789–1795
Fraser CL, Sarnacki P (1988) Parathyroid hormone mediates changes in calcium transport in uremic rat brain synaptosomes. Am J Physiol 254:F837–F844
Fraser CL, Sarnacki P, Budayr A (1988) Evidence that parathyroid hormone mediated calcium transport in rat brain synaptosomes is independent of cAMP. J Clin Invest 81:982–988
Kucharczyk J, Fraser CL, Arieff AI (1989) Hyponatremia and the central nervous system. In: Griffs RC, Arieff AI (eds) Neurologic manifestations of systemic disorders. Little, Brown & Co., Boston (in press)
Katz B, Miledi R (1971) The release of acetylcholine from nerve endings by graded electric pulses. Proc R Soc Lomd B Biol Sci 167:23–38
Barritt GJ (1982) Calcium movement across cell membrane. In: The role of calcium in biological systems. Boca Raton, FI CRC
Blaustein MP, Oborn CJ (1975) The influence of sodium and calcium fluxes in pinched-off nerve terminals in vitro. J Physiol (London) 247:657–686
Reuter H, Mullins LJ (1979) The dependence of calcium efflux from cardiac muscle on temperature and external ion composition. Q Rev Biphys 12:371–460
Phillipson KD, Nishimoto AY (1982) Stimulation of Na-Ca exchange in cardiac sarcolema vesicles by proteinase pretreatment. Am J Physiol 243:C191–C195
Verkman AS, Fraser CL (1986) Water and non-electrolyte permeability in brain synaptosomes isolated from normal and uremic rats. Am J Physiol (Regulatory, Integrative and Comparitive Physiology) 250(2):R306–R312
Bogdanski TP, Blaszkowski TP, Tissari AH (1970) Mechanisms of biogenic amine transport and storage IV. Relationship between K + and Na+ requirement for transport and storage of 5-hydroxy tryptamine and norephinephrine in synaptosomes. Biochim Biphys Acta 211:521–532
Bogdanski DF, Brodie BB (1966) Role of sodium and potassium ions in storage of norepi-nephrine by synaptic nerve endings. Life Sci 5:1563–1569
Davis RA, Kern F, Showalter R, Sutherland E, Sinesky M, Simon FR (1978) Alterations of hepatic Na-K ATPase and bile flow by estrogen: effects on liver surface membrane lipid structure and function. Proc Natl Acad Sci 75:4130–4134
Iversen LL, Kravitz EA (1966) Sodium dependence of transmitter uptake at adrenergic nerve terminals. Mol Pharmacol 2:360–362
Bogdanski DF, Tissari AH, Brodie BB (1968) Role of sodium potassium, ouabain and re-serpine in uptake, storage and metabolism of biogenic amines in synaptosomes. Life Sci 7:419–428
Bogdanski DF, Brodie BB (1969) The effects of inorganic ions on the storage and uptake 3 H norepinephrine by rat heart slices. J Pharm Exp Ther 165:181–189
Kometiani ZP, Tsakadze LG, Jariashvili (1984) Functional significance of the effects of neurotransmitters on the Na-K ATPase system. J Neurochem 42:1246–1250
Paton DM (1968) Cations and metabolic requirements for retention of metaraminol by rat uterine horns. Br J Pharmacol Chemother 33:277–286
Tissari AH, Schonhoffer PS, Bogdanski DF, Brodie BB (1969) Mechanism of biogenic transport. II. Relationship between sodium and the mechanism of ouabain blockade of the accumulation of serotonin and norepinephrine by synaptosomes. Mol Pharm 5:593–604
Ali F, Tayeb O, Attallah A (1985) Plasma and brain cathecholamines in experimental uremia: Acute and chronic studies. Life Sci 37:1757–1764
Hennemann H, Hevendehl G, Horler E, Heidland A (1973) Toxic sympathicopathy in uraemia. Proc Eur Dialysis Transpl Assoc 10:166–170
Perry TL, Yon VW, Kish SJ, Ito M, Foulks JG, Godolphin WJ, Sweeney VP (1985) Neurochemical abnormalities in brain of renal failure patients treated by repeated hemodialysis. J Neurochem 45:1043–1048
Fraser CL, Arieff AI (1989) Water metabolism and its disorders. In: Cohen RD, Alberti KGMM, Lewis B, Denman AM (eds) The molecular and metabolic basis of acquired disease. Bailliere Tindall, London
Arieff AI (1987) Hyponatremia associated with permanent brain damage. Adv Intern Med 32:325–344
Arieff AI, Llach F, Massry SG (1976) Neurological manifestations and morbidity of hyponatremia: Correlation with brain water and electrolytes. Medicine 55:121–129
Melton JE, Patlak CS, Pettigrew KD, Cserr HF (1987) Volume regulatory loss of NA, Cl, and K from rat brain during acute hyponatremia. Am J Physiol 252:F661–F669
Arieff AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529–1535
Ashouri OS (1986) Severe diuretic-induced hyponatremia in the elderly: A series of eight patients. Arch Intern Med 146:1355–1357
Ashraf N, Locksley R, Arieff AI (1981) Thiazide-induced hyponatremia associated with death or neurologic damage in outpatients. Am J Med 70:1163–1168
Ayus JC, Krothapalli RK, Arieff AI (1988) Sexual difference in survival with severe symptomatic hyponatremia. Kidney Int 33:180
Fraser CL, Kucharczyk J, Arieff AI, Rollin C, Sarnacki P, Norman D (1989) Sex differences result in increased morbidity from hyponatremia in female rats. Am J Physiol: Regul, Integ & Compar Physiol 256:R880–R885
Fraser CL, Sarnacki P (1989) Na-K ATPase pump function in rat brain synaptosomes is different in males and females. Am J Physiol: Endocrinology and Metabolism 257 (Aug)
Labella FS, Bihle I, Kim RS (1984) Progesterone derivatives that bind to the digitalis receptor: Effects on 86Rb uptake and contractility in the isolated guinea pig heart. Can J Physiol Pharm 62:1057–1064
Guerra M, Rodriques del Castillo A, Battaner E, Mas M (1987) Androgens stimulate preoptic area Na+, K+-ATPase activity in male rats. Neurosci Lett 78:97–100
Schwarz SM, Bostwick HE, Medow MS (1988) Estrogen modulates ileal basolateral membrane lipid dynamics and Na+-K+-ATPase activity. Am J Physiol 254:G687–G694
Rodriquez del Castello A, Battaner E, Guerra M, Alonso T, Mas M (1987) Regional changes of brain Na+, K+-transporting adenosine triphosphate related to ovarian function. Brain Res 416:113–118
Feefe EB, Scharschmidt BF, Blankenship NM, Ockner RK (1979) Studies of relationships among bile flow, liver plasma membrane Na-K ATPase, and membrane microviscosity in the rat. J Clin Invest 64:1590–1598
Lijnen P, Groeseneken D, Lommelen L, M’Buyamba-Kabangu JR, Amery A (1985) In vitro inhibition of renal sodium-potassium ATPase activity by progesterone. Meth Find Exptl Clin Pharmacol 7:347–349
Arieff AI, Guisado R (1976) Effects on the central nervous system of hypernatremic and hyponatremic states. Kidney Int 10:41–53
Ayus JC, Krothapalli RK, Arieff AI (1987) Treatment of severe symptomatic hyponatremia: A prospective study. N Engl J Med 317:1190–1195
Verbalis JG, Drutarosky MD (1988) Adaptation to chronic hypoosmolality in rats. Kidney Int 34:351–360
Fraser CL (1989) Neurologic manifestations of uremia and disorders of calcium metabolism. In: Griggs RC, Arieff AI (eds) Neurologic manifestations of systemic disorders. Little, Brown & Co, Boston (in press)
Burcar PJ, Norenberg MD, Yarnell PR (1977) Hyponatremia and central pontine myelinolysis. Neurology 27:223–226
Messert B, Orrison W, Hawkins M, Quaglieri C (1979) Central pontine myelinolysis. Neurology 29:147–160
Norenberg MD, Leslie KO, Robertson AS (1982) Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 11:128–135
Tomlinson BE, Pierides AM, Bradley WG (1976) Central pontine myelinolysis: Two cases with associated electrolyte disturbance. Quart J Med 179:373–386
Sterns RH, Riggs JE, Schochet SS (1986) Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 314:1535–1542
Gillis CN, Paton DM (1967) Cation dependence of sympathetic transmitter retention by slices of rat ventricle. Br J Pharmacol Chemother 29:309–318
McKee A, Winkelman M, Banker B (1988) Central pontine myelinolysis in severely burned patients: Relationship to serum hyperosmolality. Neurol 38:1211–1217
Ayus JC, Olivero JJ, Frommer JP (1982) Rapid correction of severe hyponatremia with intravenous hypertonic saline. Am J Med 72:43–48
Cheng JC, Zikos D, Skopicki HA, Peterson DR, Fisher KA (1988) Correction of symptomatic hyponatremia. Kidney Int 33:186
Decaux G, Unger J, Brimioulle S, Mockel J (1982) Hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone. JAMA 247:471–474
Hantman D, Rossier B, Zohlman R, Schrier R (1973) Rapid correction of hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone: An alternative treatment to hypertonic saline. Ann Intern Med 78:870–875
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1989 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Fraser, C.L., Arieff, A.I. (1989). Pathophysiology of the Encephalopathies Associated with Uremia and Hyponatremia. In: Bihari, D., Holaday, J.W. (eds) Brain Failure. Update in Intensive Care and Emergency Medicine, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83929-0_8
Download citation
DOI: https://doi.org/10.1007/978-3-642-83929-0_8
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-51655-2
Online ISBN: 978-3-642-83929-0
eBook Packages: Springer Book Archive