Neurologic presentations of renal diseases

Renal diseases-related metabolic abnormalities cause diverse CNS disturbances, namely uremic encephalopathy, seizures, stroke, movement disorders, sleep alterations, and peripheral nervous system involvement comprising polyneuropathy, mononeuropathies, and myopathy. Some inherited and acquired renal diseases present with concomitant or precedent neurologic syndromes. Several mechanisms involved include toxic metabolic accumulation, hyperkalemia, hypercoagulability, immunologic disturbances, and tubular acido-basic disequilibrium. Clinical symptoms usually indicate severe renal dysfunction, but subtle abnormalities may occur. Judiciously tailored renal replacement therapy may avoid these complications, whereas others may emerge from these very therapies with overlapping clinical pictures. This makes an already complex management of renal patients even more difficult and asks for tight collaboration between nephrologists and neurologists.