North Texas Research Forum 2026
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Division
North Texas
Hospital
Medical City Arlington
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2026
Keywords
uremic encephalopathy, dialysis disequilibrium syndrome, DDS, renal failure, hemodialysis, end-stage renal disease
Disciplines
Internal Medicine | Male Urogenital Diseases | Medicine and Health Sciences | Therapeutics
Abstract
Introduction Uremic encephalopathy and dialysis disequilibrium syndrome (DDS) are distinct neurologic complications of renal failure that can precipitate seizures. While uremic encephalopathy reflects toxin-mediated metabolic dysfunction, DDS may occur during hemodialysis initiation from rapid osmotic shifts. They are usually described as separate entities, particularly in established CKD. Sequential neurologic events spanning the pre-dialysis period and dialysis initiation in previously undiagnosed renal failure are poorly characterized.
Case presentation A previously healthy African American man in his 30s with no known history of kidney disease presented with new-onset generalized tonic-clonic seizure accompanied by respiratory distress. Initial laboratory testing revealed profound azotemia with severe metabolic derangements consistent with end-stage renal disease (ESRD) physiology. Cross-sectional imaging demonstrated a solitary kidney without prior documented renal evaluation. During the same admission, he was newly diagnosed with HIV. Family history was notable for lupus nephropathy in his father; however, an extensive autoimmune workup in the patient was unrevealing. Neuroimaging excluded acute intracranial hemorrhage, mass lesion, and radiographic evidence of opportunistic infection. In the setting of extreme uremia, the presenting seizure was most consistent with uremic encephalopathy, a recognized neurologic manifestation of advanced renal failure. Hemodialysis was initiated. During an early dialysis session, he developed recurrent seizure with abrupt neurologic deterioration. Given the tight temporal association with dialysis initiation and the markedly elevated baseline azotemia, dialysis disequilibrium syndrome (DDS) was suspected, a complication linked to rapid solute reduction and cerebral edema risk. Dialysis was immediately modified to a slower, staged clearance strategy. No further seizures occurred, and the patient’s neurologic status steadily improved with ongoing renal replacement therapy.
Learning Pearls
1. Severe renal dysfunction with neurologic symptoms constitutes an urgent indication for renal replacement therapy, as encephalopathy and seizures due to uremia are potentially reversible with dialysis.
2. The discovery of a new comorbidity during hospitalization should not narrow the differential prematurely. Clinicians must guard against anchoring bias and continue systematic evaluation of common etiologies.
3. Delayed presentation of advanced disease highlights the importance of routine preventive care, early screening, and timely engagement with the healthcare system to reduce morbidity from potentially modifiable conditions.
Conclusion This case illustrates a clinically important overlap between metabolic encephalopathy and dialysis-related neurologic injury in severe, previously unrecognized end-stage renal disease in the setting of a solitary kidney and concurrent newly identified HIV infection, followed by an intradialytic seizure concerning for dialysis disequilibrium syndrome. The occurrence of both a pre-dialysis seizure attributed to severe uremia and a subsequent intradialytic seizure temporally linked to hemodialysis initiation is infrequently detailed in the literature. This case underscores the importance of early recognition of overlapping metabolic and treatment-related neurologic risk and supports staged, low-efficiency dialysis initiation to mitigate neurologic complications in profoundly azotemic patients.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Dahat, Purva; Nguyen, Jessica; Abuelayyan, Sara; and Andrabi, Amnah, "Tricenarian Seizure Cascade: Uremic Encephalopathy and Suspected Dialysis Disequilibrium" (2026). North Texas Research Forum 2026. 76.
https://scholarlycommons.hcahealthcare.com/northtexas2026/76