Distinctive Electrophysiological Features of Denervated Muscle in Uremic Patients

Remtulla, Hussein; Toth, Betsy; Bernardi, Linda; Lindsay, Robert M.; Maryniak, Oleh; Burton, Stephen R.

doi:10.1097/00004691-199711000-00011

Cited by 11 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Needle electromyography may detect distal denervation. Renal failure superimposed on DPN is thought to suppress abnormal spontaneous activity such that denervation may be more difficult to recognize 16. Motor unit recruitment is reduced in distal muscles of patients with DPN and remaining units are remodeled and enlarged, indicating chronic denervation with reinnervation.…”

Section: Neurophysiologymentioning

confidence: 99%

Diabetes mellitus and the peripheral nervous system: Manifestations and mechanisms

2007

View full text Add to dashboard Cite

Diabetes targets the peripheral nervous system with several different patterns of damage and several mechanisms of disease. Diabetic polyneuropathy (DPN) is a common disorder involving a large proportion of diabetic patients, yet its pathophysiology is controversial. Mechanisms considered have included polyol flux, microangiopathy, oxidative stress, abnormal signaling from advanced glycation endproducts and growth factor deficiency. Although some clinical trials have demonstrated modest benefits in disease stabilization or pain therapy in DPN, robust therapy capable of reversing the disease is unavailable. In this review, general aspects of DPN and other diabetic neuropathies are examined, including a summary of recent therapeutic trials. A particular emphasis is placed on the evidence that the neurobiology of DPN reflects a unique yet common and disabling neurodegenerative disorder.

show abstract

Section: Neurophysiologymentioning

confidence: 99%

Diabetes mellitus and the peripheral nervous system: Manifestations and mechanisms

2007

View full text Add to dashboard Cite

show abstract

“…A small number of ESKD patients with diabetes have also been shown to develop a subacute neuropathy progressing over a few months, with severe muscle weakness. In this group of patients, nerve conduction studies may demonstrate features of either a demyelinating or axonal neuropathy 26, 27, 165. Although the presence of diabetes complicates assessment of nerve conduction data, the absence of preexisting neuropathic symptoms and the clinical improvement noted following dialysis or renal transplantation suggest a metabolic basis for the neuropathy, related to the underlying ESKD.…”

Section: Clinical and Neurophysiological Findings In Generalized Uremmentioning

confidence: 99%

Uremic neuropathy: Clinical features and new pathophysiological insights

2006

View full text Add to dashboard Cite

Neuropathy is a common complication of end-stage kidney disease (ESKD), typically presenting as a distal symmetrical process with greater lower-limb than upper-limb involvement. The condition is of insidious onset, progressing over months. and has been estimated to be present in 60%-100% of patients on dialysis. Neuropathy generally only develops at glomerular filtration rates of less than 12 ml/min. The most frequent clinical features reflect large-fiber involvement, with paresthesias, reduction in deep tendon reflexes, impaired vibration sense, muscle wasting, and weakness. Nerve conduction studies demonstrate findings consistent with a generalized neuropathy of the axonal type. Patients may also develop autonomic features, with postural hypotension, impaired sweating, diarrhea, constipation, or impotence. The development of uremic neuropathy has been related previously to the retention of neurotoxic molecules in the middle molecular range, although this hypothesis lacked formal proof. Studies utilizing novel axonal excitability techniques have recently shed further light on the pathophysiology of this condition. Nerves of uremic patients have been shown to exist in a chronically depolarized state prior to dialysis, with subsequent improvement and normalization of resting membrane potential after dialysis. The degree of depolarization correlates with serum K(+), suggesting that chronic hyperkalemic depolarization plays an important role in the development of nerve dysfunction in ESKD. These recent findings suggest that maintenance of serum K(+) within normal limits between periods of dialysis, rather than simple avoidance of hyperkalemia, is likely to reduce the incidence and severity of uremic neuropathy.

show abstract

“…Metabolic derangements affecting neuromuscular capacity, including anemia, hyperparathyroidism, metabolic acidosis, sodium retention, and hyperkalemia increase in prevalence and severity with CKD progression, usually becoming clinically apparent with an estimated glomerular filtration rate (eGFR) of <45 ml/min per 1.73 m 2 (5). The accumulation of uremic toxins resulting from declines in kidney function are reported to contribute to both neuropathy and myopathy (6)(7)(8)(9). Neuromuscular complications are further compounded by age, comorbidities, and high levels of physical inactivity in the CKD population (3, [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Rate of Force Development Is Related to Maximal Force and Sit-to-Stand Performance in Men With Stages 3b and 4 Chronic Kidney Disease

Gollie¹,

Harris‐Love²,

Patel³

et al. 2021

Front. Rehabilit. Sci.

View full text Add to dashboard Cite

Introduction: The primary aims of the present study were to assess the relationships of early (0–50 ms) and late (100–200 ms) knee extensor rate of force development (RFD) with maximal voluntary force (MVF) and sit-to-stand (STS) performance in participants with chronic kidney disease (CKD) not requiring dialysis.Methods: Thirteen men with CKD (eGFR = 35.17 ±.5 ml/min per 1.73 m2, age = 70.56 ±.4 years) and 12 non-CKD men (REF) (eGFR = 80.31 ± 4.8 ml/min per 1.73 m2, age = 70.22 ±.9 years) performed maximal voluntary isometric contractions to determine MVF and RFD of the knee extensors. RFD was measured at time intervals 0–50 ms (RFD0−50) and 100–200 ms (RFD100−200). STS was measured as the time to complete five repetitions. Measures of rectus femoris grayscale (RF GSL) and muscle thickness (RF MT) were obtained via ultrasonography in the CKD group only. Standardized mean differences (SMD) were used to examine differences between groups. Bivariate relationships were assessed by Pearson's product moment correlation.Results: Knee extensor MVF adjusted for body weight (CKD=17.14 ±.1 N·kg0.67, REF=21.55 ±.3 N·kg0.67, SMD = 0.79) and STS time (CKD = 15.93 ±.4 s, REF = 12.23 ±.7 s, SMD = 1.03) were lower in the CKD group than the REF group. Absolute RFD100−200 was significantly directly related to adjusted MVF in CKD (r = 0.56, p = 0.049) and REF (r = 0.70, p = 0.012), respectively. STS time was significantly inversely related to absolute (r = −0.75, p = 0.008) and relative RFD0−50 (r = −0.65, p = 0.030) in CKD but not REF (r = 0.08, p = 0.797; r = 0.004, p = 0.991). Significant inverse relationships between RF GSL adjusted for adipose tissue thickness and absolute RFD100−200 (r =−0.59, p = 0.042) in CKD were observed.Conclusion: The results of the current study highlight the declines in strength and physical function that occur in older men with CKD stages 3b and 4 not requiring dialysis. Moreover, early RFD was associated with STS time in CKD while late RFD was associated MVF in both CKD and REF.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT03160326 and NCT02277236.

show abstract

Distinctive Electrophysiological Features of Denervated Muscle in Uremic Patients

Abstract: Abnormal spontaneous activity is a hallmark of acute or subacute denervation of skeletal muscle, particularly in patients with uremic neuropathy. We report 5 patients in whom such activity was unexpectedly minimal or absent.

Cited by 11 publications

References 18 publications

Diabetes mellitus and the peripheral nervous system: Manifestations and mechanisms

Diabetes mellitus and the peripheral nervous system: Manifestations and mechanisms

Uremic neuropathy: Clinical features and new pathophysiological insights

Rate of Force Development Is Related to Maximal Force and Sit-to-Stand Performance in Men With Stages 3b and 4 Chronic Kidney Disease

Contact Info

Product

Resources

About