Uraemic Encephalopathy — ESENeph MCQ

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HardChronic Kidney DiseaseUraemic EncephalopathyESENeph

A 55-year-old man presents with confusion, visual hallucinations, and asterixis. His eGFR is 6 mL/min/1.73m2, urea is 55 mmol/L, creatinine is 750 umol/L. He has been declining dialysis but his family is concerned. What is this clinical presentation called?

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Correct answer: E — Uraemic encephalopathy

Uraemic encephalopathy is a serious complication of advanced untreated kidney failure caused by accumulation of uraemic toxins. Symptoms include confusion, altered consciousness, asterixis (metabolic flap), myoclonus, seizures, and visual hallucinations. It is an indication for urgent dialysis initiation. In the context of a patient declining dialysis, a careful conversation about goals of care and capacity assessment is needed. If the patient has capacity and understands the consequences, their decision should be respected.

Reference: NICE NG107 2018 – RRT; KDIGO 2024 – CKD