Renal Disease
Uremia: symptomatic renal failure.
Uremic Encephalopathy
Signs: dysarthria, unsteady gait, asterixis, tremor, multifocal myoclonus, obtundation. Day-to-day fluctuation.
Also: tetany, restless legs syndrome, meningismus (often with high CSF protein, pleocytosis). Seizures late manifestation. Renal failure alters drug clearance, protein-binding; follow free levels of anticonvulsant drugs.
Encephalopathy clears with hemodialysis.
Uremic Neuropathy
Most common neurologic complication of chronic renal failure. Distal, symmetric, mixed sensorimotor neuropathy affects legs more than arms. Primarily axonal, secondary demyelination. Much more common in men than in women. Mononeuropathy may occur.
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