Eletrencefalograma antes e após hemodiálise, diálise peritoneal e transplante renal: estudo de correlações da atividade de fundo com a bioquímica plasmática

Resende, Luiz Antonio de Lima; Speciali, José Geraldo

doi:10.1590/S0004-282X1987000300005

Resumos

Estudamos as correlações entre atividade de fundo no EEG e anormalidades bioquímicas do plasma em 49 pacientes com insuficiência renal crônica. Foi realizado estudo do EEG e bioquímico antes e após hemodiálise em 20 pacientes, antes e após diálise peritoneal em 14 e antes e após transplante renal em 15 pacientes. Observamos piora do EEG após hemodiálise e diálise peritoneal e melhora do EEG após transplante, sugerindo que em nossos pacientes as alterações da atividade de fundo induzidas pela uremia crônica eram reversíveis. Com base em nossos resultados, consideramos difícil estabelecer correlações entre o EEG e alterações da bioquímica plasmática. Entretanto, há correlação estatística entre hipernatremia, melhora da acidose metabólica, aumento da relação zinco/cobre e piora da atividade de fundo no EEG.

We report disorganization of background activity in the EEG of 49 patients with chronic renal failure. An electroencephalographic and biochemical study was performed in 20 patients before and after dialysis sessions. We did the same study before and after peritoneal dialysis in 14 patients. We analysed the EEG compared to biochemical blood abnormalities before and after renal transplantation in 15 patients. We observed worsening of the EEG after hemodialysis and peritoneal dialysis and improvement after renal transplantation, suggesting that in our patients the abnormalities in EEG caused by chronic renal failure were reversible. From our results, we found it difficult to establish correlations between the EEG and the biochemical blood abnormalities. However, there is statistical correlation between hipernatremia, improvement of metabolic acidosis, increase of the ratio of zinc to copper and worsening of the background activity in EEG.

Eletrencefalograma antes e após hemodiálise, diálise peritoneal e transplante renal: estudo de correlações da atividade de fundo com a bioquímica plasmática

Electroencephalogram before and after hemodyalisis, peritoneal dialysis and renal transplant: study of correlations between background activity and plasmatic biochemistry

Luiz Antonio de Lima Resende^I; José Geraldo Speciali^II

^IMestre em Neurologia - Trabalho realizado no Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo

^IIProfessor Livre-Docente - Trabalho realizado no Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo

RESUMO

Estudamos as correlações entre atividade de fundo no EEG e anormalidades bioquímicas do plasma em 49 pacientes com insuficiência renal crônica. Foi realizado estudo do EEG e bioquímico antes e após hemodiálise em 20 pacientes, antes e após diálise peritoneal em 14 e antes e após transplante renal em 15 pacientes. Observamos piora do EEG após hemodiálise e diálise peritoneal e melhora do EEG após transplante, sugerindo que em nossos pacientes as alterações da atividade de fundo induzidas pela uremia crônica eram reversíveis. Com base em nossos resultados, consideramos difícil estabelecer correlações entre o EEG e alterações da bioquímica plasmática. Entretanto, há correlação estatística entre hipernatremia, melhora da acidose metabólica, aumento da relação zinco/cobre e piora da atividade de fundo no EEG.

SUMMARY

We report disorganization of background activity in the EEG of 49 patients with chronic renal failure. An electroencephalographic and biochemical study was performed in 20 patients before and after dialysis sessions. We did the same study before and after peritoneal dialysis in 14 patients. We analysed the EEG compared to biochemical blood abnormalities before and after renal transplantation in 15 patients. We observed worsening of the EEG after hemodialysis and peritoneal dialysis and improvement after renal transplantation, suggesting that in our patients the abnormalities in EEG caused by chronic renal failure were reversible. From our results, we found it difficult to establish correlations between the EEG and the biochemical blood abnormalities. However, there is statistical correlation between hipernatremia, improvement of metabolic acidosis, increase of the ratio of zinc to copper and worsening of the background activity in EEG.

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Full text available only in PDF format.

Depto. de Neuropsiquiatria e Psicol. Médica, Faculdade de Medicina - 14049 - Ribeirão Preto, SP - Brasil.

1. ARIEFF, A.I. & GUISABO, R. - Effects on the central nervous system of hypernatremic and hyponatremic states. Kidney Internat. 10:104, 1976.
2. ATKIN-THOR, E.; GODDARD, B.W.; O'NION, J.; STEPHEN, R.L. & KOLFF, W.J. - Hypogeusia and zinc depletion in chronic dialysis patients. Amer. J. clin. Nutr. 31:1948, 1978.
3. BOEN, S.T. - Kinetics of peritoneal dialysis: a comparison with the artificial kidney. Medicine 40:243, 1960.
4. BOURNE, J.R.; WARD, J.W.; TESCHAN, P.E. ; MUSSO, M. ; JOHNSTON, H.B. & GINN, H.E. - Quantitative assesment of the electroencephalogram in renal disease. Electroenceph. clin. Neurophysiol. 39:377, 1975.
5. COGAN, M.G.; COVEY, CM. ; ARIEFF, A.I.; WISNIEWSKI, A. & CLARK, O.H. - Central nervous system manifestations of hyperparathyroidism. Amer. J. Med. 65:963, 1978.
6. COHN, R.; KOLB, L.C & MULDER, D.W. - Electroencephalographc changes induced by water intoxication. J. nerv. ment. Dis. 106:513, 1947.
7. CONDON, C.J. & FREEMAN, R.M. - Zinc metabolism in renal failure. Ann. int. Med. 73:531, 1970.
8. DAVIDOFF, L.M. - Pseudotumor cerebri: benign intracranial hypertension. Neurology 6:605, 1956.
9. DOSSETOR, J.B. ; OH, J.H.; DAYES, L. & PAPPIUS, H.M. - Brain urea and water changes with rapid hemodialysis of uremic dogs. Trans. Amer. Soc. Artif. Int. Organs 10:323, 1964.
10. ENGEL, G.L. ; ROMANO, J.; FERRIS, E.B. ; WEBB, J.P. & STEVENS, C.D. - A simple method of determining frequency spectrums in the electroencephalogram. Arch. Neurol. Psychiat. 51:134, 1944.
11. FISHMAN, R.A. & RASKIN, N.H. - Experimental uremic encephalopathy: permeability and electrolyte metabolism of brain and other tissues. Arch. Neurol. 17:10, 1967.
12. FORSTER, F.M. & NIMS, L.F. - Electroencephalographs effects of acute increases of intracranial pressure. Arch. Neurol. Psychiat. 47:449, 1942.
13. FREEMON, R.B.; SHEFF, M.F. ; MAHER, J.F.; & SCHREINER, G.E. - The blood-cerebrospinal fluid barrier in uremia. Ann. int. Med. 56:233, 1962.
14. FUNCK-BRENTANO, J.L.; LOSSKY-NEEHAROCHEFF, I. & ALTMAN, J. - Etude expérimentale des manifestations cérébrales de l'intoxication par l'eau. Electroenceph. clin. Neurophysiol. 12:185, 1960.
15. GASTAUT, J.L.; MICHEL, B.; SABETHASSAN, S.; CERDA, M.; BIANCHI, L. & GASTAUT, H. - Electroencephalography in brain edema (127 cases of brain tumor investigated by cranial computerized tomography). Electroenceph. clin. Neurophysiol. 46:239, 1979.
16. GELLHORN, E. & BALLIN, H.M. - Water intoxication and the electroencephalogram. Amer. J. Physiol. 146:559, 1946.
17. GILLILAND, K.G. & HERGSTROM, R.M. - The effect of hemodialysis on cerebrospinal fluid pressure in uremic dogs. Trans. Amer. Soc. Artif. Int. Organs 9:44, 1963.
18. GLOOR, P.; JACOB, J.C; ELWAN, O.H.; DOSSETOR, J.B. & PATERAS, V.R. - The electroencephalogram in chronic renal failure. In H. Gastaut, H. Jasper, J. Bancaud & A. Waltrégny (eds.): The physiopathogenesis of the epilepsies. Thomas, Springfield, 1969, pg. 50.
19. GORDON, E.F.; GORDON, R.C & PASSAL, D.B. - Zinc metabolism: basic, clinical and behavioral aspects. J. Pediatr. 99:341, 1981.
20. HAMBIDGE, K.M.; HAMBIDGE, C.; JACOBS, M. & BAUM, J.D. - Low levels of zinc in hair, anorexia, poor growth and hypogeusia in children. Pediatr. Res. 6:868, 1972.
21. HAMEL, B.; BOURNE, J.R.; WARD, J.W. & TESCHAN, P.E. - Quantitative assesment of photic driving in renal failure. Electroenceph. clin. Neurophysiol. 45:719, 1978.
22. HAMPERS, C.L.; DOAK, P.B.; CALLAGHAN, M.N.; TYLER, R. & MERRIL, J.P. - The electroencephalogram and spinal fluid during hemodialysis. Arch, int Med. 118:340, 1966.
23. HUGHES, J.R. - Correlations between EEG and chemical changes in uremia. Electroenceph. clin. Neurophysiol. 48:583, 1980.
24. JACOB, J.C; GLOOR, P.; ELWAN, O.H. ; DOSSETOR, J.B. & PATERAS, V.R. - Electroencephalographic changes in chronic renal failure. Neurology 15:419, 1965
25. JANNY, P. & IPTHUM, B. - Hypertension intra-cranienne. Encycl. Méd. Chir., Neurologie 17037 M-10. Masson, Paris, 1980.
26. KENNEDY, A.C. - Dialysis disequilibrium syndrome. Electroenceph. clin. Neurophysiol. 29:213, 1970.
27. KENNEDY, A.C.; LINTON, A.L. & EATON, J.C. - Urea levels in cerebrospinal fluid after hemodialysis. Lancet 1:410, 1962.
28. KENNEDY, A.C.; LINTON, A.L.; LUKE, R.G. & RENFREW, S. - Electroencephalographc changes during hemodialysis. Lancet 1:408, 1963.
29. KENNEDY, A.C; LINTON, A.L.; LUKE, R.G.; RENFREW, S. & DINWOODIE, A. - The pathogenesis and prevention of cerebral dysfunction during dialysis. Lancet 1:790, 1964.
30. KILEY, J. & HINES, O. - Electroencephalographs evaluation of uremia wave frequency evaluations on 40 uremic patients. Arch. int. Med. 116:67, 1965.
31. KLEVAY, L.M. - Coronary heart disease: the zinc/copper hypothesis. Amer. J. clin. Nutr. 28:764, 1975.
32. KLINGLER, M. - EEG observations in uremia. Electroenceph. clin. Neurophysiol. 6:519, 1954.
33. KRIETER, G. - Hypernatremia and EEG. Electroenceph. clin. Neurophysiol. 20:273, 1966.
34. LOVERO, G.; CARLUCCI, V.; CHIARULLI, G.; CASUCCI, N. & FRASCELLA, G. - Variazioni elettroencefalografiche indotte dall' emodialisi. Minerva nefrol. 7: 213, 1970.
35. MADONICK, M.J.; BERKE, K. & SCHIEFER, I. - Pleocytosis and meningeal signs in uremia. Arch. Neurol. Psychiat. 64:431, 1950.
36. MAHER, J.F. & SCHREINER, G.E. - Hazards and complications of dyalisis. N. Engl. J. Med. 273:370, 1965.
37. MAHONEY, C.A. & ARIEFF, A.I. - Central and peripheral nervous system effects of chronic renal failure. Kidney Internat. 24:170, 1983.
38. MANSOURI, K.; HALSTED, J.A. & GOMBOS, E.A. - Zinc, copper, magnesium and calcium in dialyzed and nondialyzed uremic patients. Arch. int. Med. 125:88, 1970.
39. MÉNDEZ-MARTÍN, A.; ORTIZ GONZALEZ, A. & GUTIÉRREZ GONZALES, J.R. - Variaciones de la gasometría arterial tras hemodiálisis e influencia de la antiagregación plaquetaria. Med. clin. (Barcelona) 82:885, 1984.
40. MISES, J.; LERIQUE-KOECHLIN, A. & RIMBOT, B. - The electroencephalogram during renal insufficiency. Electroenceph. clin. Neurophysiol. 25:91, 1968.
41. NIEDERMEYER, E. & LOPES DA SILVA, F. - Electroencephalography: Basic Principies, Clinical Applications and Related Fields. Urban & Schwarzenberg, Baltimore, 1982.
42. NIENHUIS, L.I. - Clinical peritoneal dialysis. Arch. Surg. 93:643, 1966.
43. OLSEN, S. - The brain in uremia. Acta, psychiat. neurol. scand. 36 (suppl. 156), 1961.
44. OREOPOULOS, D. & KHANNA, R. - Complications of peritoneal dialysis other than peritonitis. In K.D. Nolph (ed.): Peritoneal Dialysis. Developments in Nephrology, Vol. 2. Martinus Nijhoff, Dordrecht, 1981, pg. 309.
45. PABICO, R.C.; ATANACIO, B.C. & McKENNA, B.A. - Peritoneal dialysis and its effects on cerebrospinal fluid composition. Trans. Amer. Soc. Artif. Int. Organs 16:97, 1970.
46. PIECHOTA, W.; DOBRUCKI, T.; SYMONOWICZ, N.; WADOWSKA, E. & MURKOWSKA, E. - Zinc in patients with chronic renal failure. Internat. Urol. Nephrol. 15:377, 1983.
47. PLUM, F. & POSNER, J.B. - Diagnóstico de estupor e coma. Ed. 2. Guanabara Koogan, Rio de, Janeiro, 1977.
48. POSNER, J.B. & PLUM, F. - Spinal-fluid pH and neurologic symptoms in systemic acidosis. N. Engl. J. Med. 277:605, 1967.
49. PRILL, A.; QUELLHORST, E. & SCHELER, F. - Epilepsy: clinical and electro-encephalographical findings in patients with renal insufficiency. In H. Gastaut, H. Jasper, J. Bancaud & A. Waltrégny (eds.): The Physiopathogenesis of the Epilepsies. Thomas, Springfield, 1969, pg. 60.
50. RASKIN, N.H. & FISHMAN, R.A. - Neurologic disorders in renal failure. N. Engl. J. Med. 294:143, 1976.
51. RICHET, G. & VACHON, F. - Troubles neuro-psychiques de I' uremie chronique. Presse méd. 74:1177, 1966.
52. SABOURAUD, O.; CHATEL, M.; MENAÜLT, F.; PERÓN, J.D.; CARTIER, F.; GARRE, M.; GARY, J. & PECKER, S. - L' encephalopathy myoclonique progressive des dialyses: étude clinique, électroencéphalographique et neuropathologique. Rev. neurol. (Paris) 134:575, 1978.
53. SANDSTEAD, H.H. - Trace elements in uremia and hemodialyses. Amer. J. clin. Nutr. 33:1501, 1980.
54. SITIPRIJA, V. & HOLMES, J. - Intracranial and intraocular pressure during hemodialysis. Clin. Res. 12:258, 1964.
55. SWANSON, A.G. & ISERI, O.A. - Acute encephalopathy due to water intoxication. N. Engl. J. Med. 258:831, 1958.
56. SWANSON, A.G.; STAVNEY, L.S. & PLUM, F. - Effects of blood pH and carbon dioxide on cerebral electrical activity. Neurology 8:787, 1958.
57. TEMES-MONTES, X.L.; PICAPORTE, M.A.; HERRERO, E.; SELGAS, R.; BEBERIDE, J.M.; MARTINEZ-ARA, J. & SÁNCHEZ-SICILIA, L. - Valores séricos y urinarios de cinc en nefropatias exteriorizadas por síndrome nefrótico o como proteinuria en rango nefrótico. Rev. clin. esp. 159:159, 1980.
58. TESCHAN, P.E. - Assessing the adequacy of dialyses. Proc. Eur. Dial. Transplant. Assoc. 18:697, 1981.
59. TYLER, H.R. - Neurological complications of dialysis, transplantation and other forms of treatment in chronic uremia. Neurology 15:1081, 1965.
60. TYLER, H.R. - Neurologic disorders in renal failure. Amer. J. Med. 44:734, 1968.
61. TYRALA, E.E.; MANSER, J.I.; BRODSKY, N.L. & TRAN, N. - Serum zinc concentrations in growing premature infants. Acta paediatr. scand. 72:695, 1983.
62. VAAMONDE, C.A.; MICHAEL, U.F.; METZGER, R.A. & CARROL, K.E. - Complications of acute peritoneal dialysis. J. chron. Dis. 28:637, 1975.
63. VALK, T.W.; SWARTZ, R.D. & HSU, C.H. - Peritoneal dialyses in acute renal failure: analysis of outcome and complications. Dialysis Transplant. 9:48, 1980.
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65. ZYSNO, E. - EEG changes and electrolyte metabolism in uremia before and after extracortical dialysis. Electroenceph. clin. Neurophysiol. 20:273, 1966.

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Set 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARIEFF, A.I. & GUISABO, R. - Effects on the central nervous system of hypernatremic and hyponatremic states. Kidney Internat. 10:104, 1976.

[2] 2. ATKIN-THOR, E.; GODDARD, B.W.; O'NION, J.; STEPHEN, R.L. & KOLFF, W.J. - Hypogeusia and zinc depletion in chronic dialysis patients. Amer. J. clin. Nutr. 31:1948, 1978.

[3] 3. BOEN, S.T. - Kinetics of peritoneal dialysis: a comparison with the artificial kidney. Medicine 40:243, 1960.

[4] 4. BOURNE, J.R.; WARD, J.W.; TESCHAN, P.E. ; MUSSO, M. ; JOHNSTON, H.B. & GINN, H.E. - Quantitative assesment of the electroencephalogram in renal disease. Electroenceph. clin. Neurophysiol. 39:377, 1975.

[5] 5. COGAN, M.G.; COVEY, CM. ; ARIEFF, A.I.; WISNIEWSKI, A. & CLARK, O.H. - Central nervous system manifestations of hyperparathyroidism. Amer. J. Med. 65:963, 1978.

[6] 6. COHN, R.; KOLB, L.C & MULDER, D.W. - Electroencephalographc changes induced by water intoxication. J. nerv. ment. Dis. 106:513, 1947.

[7] 7. CONDON, C.J. & FREEMAN, R.M. - Zinc metabolism in renal failure. Ann. int. Med. 73:531, 1970.

[8] 8. DAVIDOFF, L.M. - Pseudotumor cerebri: benign intracranial hypertension. Neurology 6:605, 1956.

[9] 9. DOSSETOR, J.B. ; OH, J.H.; DAYES, L. & PAPPIUS, H.M. - Brain urea and water changes with rapid hemodialysis of uremic dogs. Trans. Amer. Soc. Artif. Int. Organs 10:323, 1964.

[10] 10. ENGEL, G.L. ; ROMANO, J.; FERRIS, E.B. ; WEBB, J.P. & STEVENS, C.D. - A simple method of determining frequency spectrums in the electroencephalogram. Arch. Neurol. Psychiat. 51:134, 1944.

[11] 11. FISHMAN, R.A. & RASKIN, N.H. - Experimental uremic encephalopathy: permeability and electrolyte metabolism of brain and other tissues. Arch. Neurol. 17:10, 1967.

[12] 12. FORSTER, F.M. & NIMS, L.F. - Electroencephalographs effects of acute increases of intracranial pressure. Arch. Neurol. Psychiat. 47:449, 1942.

[13] 13. FREEMON, R.B.; SHEFF, M.F. ; MAHER, J.F.; & SCHREINER, G.E. - The blood-cerebrospinal fluid barrier in uremia. Ann. int. Med. 56:233, 1962.

[14] 14. FUNCK-BRENTANO, J.L.; LOSSKY-NEEHAROCHEFF, I. & ALTMAN, J. - Etude expérimentale des manifestations cérébrales de l'intoxication par l'eau. Electroenceph. clin. Neurophysiol. 12:185, 1960.

[15] 15. GASTAUT, J.L.; MICHEL, B.; SABETHASSAN, S.; CERDA, M.; BIANCHI, L. & GASTAUT, H. - Electroencephalography in brain edema (127 cases of brain tumor investigated by cranial computerized tomography). Electroenceph. clin. Neurophysiol. 46:239, 1979.

[16] 16. GELLHORN, E. & BALLIN, H.M. - Water intoxication and the electroencephalogram. Amer. J. Physiol. 146:559, 1946.

[17] 17. GILLILAND, K.G. & HERGSTROM, R.M. - The effect of hemodialysis on cerebrospinal fluid pressure in uremic dogs. Trans. Amer. Soc. Artif. Int. Organs 9:44, 1963.

[18] 18. GLOOR, P.; JACOB, J.C; ELWAN, O.H.; DOSSETOR, J.B. & PATERAS, V.R. - The electroencephalogram in chronic renal failure. In H. Gastaut, H. Jasper, J. Bancaud & A. Waltrégny (eds.): The physiopathogenesis of the epilepsies. Thomas, Springfield, 1969, pg. 50.

[19] 19. GORDON, E.F.; GORDON, R.C & PASSAL, D.B. - Zinc metabolism: basic, clinical and behavioral aspects. J. Pediatr. 99:341, 1981.

[20] 20. HAMBIDGE, K.M.; HAMBIDGE, C.; JACOBS, M. & BAUM, J.D. - Low levels of zinc in hair, anorexia, poor growth and hypogeusia in children. Pediatr. Res. 6:868, 1972.

[21] 21. HAMEL, B.; BOURNE, J.R.; WARD, J.W. & TESCHAN, P.E. - Quantitative assesment of photic driving in renal failure. Electroenceph. clin. Neurophysiol. 45:719, 1978.

[22] 22. HAMPERS, C.L.; DOAK, P.B.; CALLAGHAN, M.N.; TYLER, R. & MERRIL, J.P. - The electroencephalogram and spinal fluid during hemodialysis. Arch, int Med. 118:340, 1966.

[23] 23. HUGHES, J.R. - Correlations between EEG and chemical changes in uremia. Electroenceph. clin. Neurophysiol. 48:583, 1980.

[24] 24. JACOB, J.C; GLOOR, P.; ELWAN, O.H. ; DOSSETOR, J.B. & PATERAS, V.R. - Electroencephalographic changes in chronic renal failure. Neurology 15:419, 1965

[25] 25. JANNY, P. & IPTHUM, B. - Hypertension intra-cranienne. Encycl. Méd. Chir., Neurologie 17037 M-10. Masson, Paris, 1980.

[26] 26. KENNEDY, A.C. - Dialysis disequilibrium syndrome. Electroenceph. clin. Neurophysiol. 29:213, 1970.

[27] 27. KENNEDY, A.C.; LINTON, A.L. & EATON, J.C. - Urea levels in cerebrospinal fluid after hemodialysis. Lancet 1:410, 1962.

[28] 28. KENNEDY, A.C.; LINTON, A.L.; LUKE, R.G. & RENFREW, S. - Electroencephalographc changes during hemodialysis. Lancet 1:408, 1963.

[29] 29. KENNEDY, A.C; LINTON, A.L.; LUKE, R.G.; RENFREW, S. & DINWOODIE, A. - The pathogenesis and prevention of cerebral dysfunction during dialysis. Lancet 1:790, 1964.

[30] 30. KILEY, J. & HINES, O. - Electroencephalographs evaluation of uremia wave frequency evaluations on 40 uremic patients. Arch. int. Med. 116:67, 1965.

[31] 31. KLEVAY, L.M. - Coronary heart disease: the zinc/copper hypothesis. Amer. J. clin. Nutr. 28:764, 1975.

[32] 32. KLINGLER, M. - EEG observations in uremia. Electroenceph. clin. Neurophysiol. 6:519, 1954.

[33] 33. KRIETER, G. - Hypernatremia and EEG. Electroenceph. clin. Neurophysiol. 20:273, 1966.

[34] 34. LOVERO, G.; CARLUCCI, V.; CHIARULLI, G.; CASUCCI, N. & FRASCELLA, G. - Variazioni elettroencefalografiche indotte dall' emodialisi. Minerva nefrol. 7: 213, 1970.

[35] 35. MADONICK, M.J.; BERKE, K. & SCHIEFER, I. - Pleocytosis and meningeal signs in uremia. Arch. Neurol. Psychiat. 64:431, 1950.

[36] 36. MAHER, J.F. & SCHREINER, G.E. - Hazards and complications of dyalisis. N. Engl. J. Med. 273:370, 1965.

[37] 37. MAHONEY, C.A. & ARIEFF, A.I. - Central and peripheral nervous system effects of chronic renal failure. Kidney Internat. 24:170, 1983.

[38] 38. MANSOURI, K.; HALSTED, J.A. & GOMBOS, E.A. - Zinc, copper, magnesium and calcium in dialyzed and nondialyzed uremic patients. Arch. int. Med. 125:88, 1970.

[39] 39. MÉNDEZ-MARTÍN, A.; ORTIZ GONZALEZ, A. & GUTIÉRREZ GONZALES, J.R. - Variaciones de la gasometría arterial tras hemodiálisis e influencia de la antiagregación plaquetaria. Med. clin. (Barcelona) 82:885, 1984.

[40] 40. MISES, J.; LERIQUE-KOECHLIN, A. & RIMBOT, B. - The electroencephalogram during renal insufficiency. Electroenceph. clin. Neurophysiol. 25:91, 1968.

[41] 41. NIEDERMEYER, E. & LOPES DA SILVA, F. - Electroencephalography: Basic Principies, Clinical Applications and Related Fields. Urban & Schwarzenberg, Baltimore, 1982.

[42] 42. NIENHUIS, L.I. - Clinical peritoneal dialysis. Arch. Surg. 93:643, 1966.

[43] 43. OLSEN, S. - The brain in uremia. Acta, psychiat. neurol. scand. 36 (suppl. 156), 1961.

[44] 44. OREOPOULOS, D. & KHANNA, R. - Complications of peritoneal dialysis other than peritonitis. In K.D. Nolph (ed.): Peritoneal Dialysis. Developments in Nephrology, Vol. 2. Martinus Nijhoff, Dordrecht, 1981, pg. 309.

[45] 45. PABICO, R.C.; ATANACIO, B.C. & McKENNA, B.A. - Peritoneal dialysis and its effects on cerebrospinal fluid composition. Trans. Amer. Soc. Artif. Int. Organs 16:97, 1970.

[46] 46. PIECHOTA, W.; DOBRUCKI, T.; SYMONOWICZ, N.; WADOWSKA, E. & MURKOWSKA, E. - Zinc in patients with chronic renal failure. Internat. Urol. Nephrol. 15:377, 1983.

[47] 47. PLUM, F. & POSNER, J.B. - Diagnóstico de estupor e coma. Ed. 2. Guanabara Koogan, Rio de, Janeiro, 1977.

[48] 48. POSNER, J.B. & PLUM, F. - Spinal-fluid pH and neurologic symptoms in systemic acidosis. N. Engl. J. Med. 277:605, 1967.

[49] 49. PRILL, A.; QUELLHORST, E. & SCHELER, F. - Epilepsy: clinical and electro-encephalographical findings in patients with renal insufficiency. In H. Gastaut, H. Jasper, J. Bancaud & A. Waltrégny (eds.): The Physiopathogenesis of the Epilepsies. Thomas, Springfield, 1969, pg. 60.

[50] 50. RASKIN, N.H. & FISHMAN, R.A. - Neurologic disorders in renal failure. N. Engl. J. Med. 294:143, 1976.

[51] 51. RICHET, G. & VACHON, F. - Troubles neuro-psychiques de I' uremie chronique. Presse méd. 74:1177, 1966.

[52] 52. SABOURAUD, O.; CHATEL, M.; MENAÜLT, F.; PERÓN, J.D.; CARTIER, F.; GARRE, M.; GARY, J. & PECKER, S. - L' encephalopathy myoclonique progressive des dialyses: étude clinique, électroencéphalographique et neuropathologique. Rev. neurol. (Paris) 134:575, 1978.

[53] 53. SANDSTEAD, H.H. - Trace elements in uremia and hemodialyses. Amer. J. clin. Nutr. 33:1501, 1980.

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