The Peripheral Nerve Function in Chronic Renal Failure

Abstract

Abstract. Sensory and motor nerve conduction has been measured in 56 patients with chronic renal failure. Slowed nerve conduction was present in one or more segments in 38 of 39 patients with a 24‐hour creatinine clearance below 10 ml/min/1.73 m2. The impairment involved upper and lower extremities, motor and sensory fibres, distal and proximal segments, and fast and more slowly conducting fibres. The amplitude of sensory action potentials was reduced, mainly due to increased temporal dispersion and to increased incidence of irregularities in the shape of potentials. The electromyographic contraction pattern at maximal effort in the abd. poll. brev. muscle was rarely abnormal, whereas the pattern in the ext. dig. brev. muscle was compatible with a moderate to severe loss of motor units in 21 of 29 patients. All patients with electrophysiological signs of impaired nerve function had slowed motor conduction in the common peroneal nerve and/or slowed sensory conduction in the median nerve. The demonstration in the present material of an almost uniform slowing of nerve conduction in all segments examined contrasts with the reported distribution of structural changes, predominantly located in the distal parts of the legs. The hypothesis is put forward that the slowing of nerve conduction is not solely dependent on structural changes, but also on a universal toxic effect upon the nerve axon membrane by uremic toxin(s) other than urea and creatinine.

Transient Changes of Sensory Nerve Functions in Uraemia

“…For this reason we have studied bow an acute change in the metabolite concentration in serum, associated with renal failure and/or a single haemodialysis session, affects the electrophysiological parameters of the peripheral sensory nerves. In our opinion the result supports Nielsen's theory (17,18) that the slowing of NCV in uraemic intoxication is at least partly functional and reversible.…”

“…According to Thomas (24) it is questionable whether the slight morphological changes in peripheral nerves can account for the mild slowing of nerve conduction so often observed in initial stages of uraemia. Nielsen (17,18) has advanced the theory that the slowing of nerve conduction in chronic uraemia can also be due to an inhibition of the transmembrane sodium pump caused by humoral toxic factor(s) in the serum. The slowing down of NCV would thus be functional and reversible in character.…”

Review: Neuromuscular Disease in the Dialysis Patient: An Update for the Nephrologist

“…Nerve conduction studies remain the mainstay in the diagnosis of uremic neuropathy. In length‐dependent uremic neuropathy, NCS demonstrate features of a generalized neuropathy of the axonal type, with reduction in sensory amplitudes and to a lesser extent, motor amplitudes (4,5,33,34). Sensory and motor conduction velocities are relatively preserved and needle electromyography may reveal changes in denervation in distal lower limb muscles (35).…”

“…generalized neuropathy of the axonal type, with reduction in sensory amplitudes and to a lesser extent, motor amplitudes (4,5,33,34). Sensory and motor conduction velocities are relatively preserved and needle electromyography may reveal changes in denervation in distal lower limb muscles (35).…”

Impact of Renal Posttransplantation Amputation on Allograft Outcomes

“…Diabetic patients are at increased risk for PVD leading to amputation (6,7), whereas nondiabetic ESRD patients also may have risk factors for amputation (8,9). Transplantation is the modality of choice in ESRD patients (10), but cardiovascular disease remains the leading cause of morbidity and mortality in these patients compared with the general population.…”