The utility of the Total Neuropathy Score as an instrument to assess neuropathy severity in chronic kidney disease: A validation study

Issar, Tushar; Arnold, Ria; Kwai, Natalie; Pussell, Bruce A.; Endre, Z. H.; Poynten, Ann M.; Kiernan, Matthew C.; Krishnan, Arun V.

doi:10.1016/j.clinph.2018.02.120

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…The diagnostic specificity was found to be high in both neuropathy due to impaired glucose intolerance 29 and neuropathy resulting from chronic kidney disease. 30 The latter study had a score of 0 in all of the 40 controls from an age group matching that of our patients. The literature describes ALA patients as having substantial pain and also involvement of autonomic functions.…”

Section: Discussionmentioning

confidence: 93%

Comparing neuropathy in multiple myeloma and AL amyloidosis

Ballegaard

Nelson

Gimsing

2021

J Peripheral Nervous Sys

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Peripheral neuropathy (PN) is frequent in patients with monoclonal gammopathy due to plasma cell dyscrasia, but little is known about the comparative impact of nerve dysfunction in different disorders. We compared clinical and laboratory results between two diagnostic groups. We recruited 76 untreated multiple myeloma (MM) and 27 AL amyloidosis (ALA) patients for evaluation of symptoms, clinical findings and nerve conduction studies (NCS). We diagnosed significant PN using total neuropathy scores (TNS > 7) in 17.6% of MM and 48.1% of ALA patients and in 27.7% of MM and 35.7% of ALA patients using NCS findings. TNS score grades were significantly higher in the AL amyloidosis patients (Fisher's exact test: P = .02) but a NCS based PN diagnosis was not significantly different (Fisher's exact test: P = .13). A significantly higher TNS vibration (P = .04) and pin (P = .02) sensory sign and TNS reflex (P = .04) sign score was found in amyloidosis patients. Likewise, quantitative sensory thresholds for vibration was higher in amyloidosis patients (Welsh ANOVA: P = .01). NCS revealed signs of more frequent axonal tibial neuropathy with significantly lower motor response amplitudes (P = .02) and resulting higher TNS scores (P = .002), while sural nerve sensory response amplitudes were without significant difference (P = .86). We found more severe TNS grades of PN in AL amyloidosis patients compared with MM patients. We also found higher sensory symptoms scores and higher thresholds for vibration but similar sensory involvement using NCS. The NCS exclusively showed signs of an axonal neuropathy.

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Section: Discussionmentioning

confidence: 93%

Comparing neuropathy in multiple myeloma and AL amyloidosis

Ballegaard

Nelson

Gimsing

2021

J Peripheral Nervous Sys

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“…Neuropathy severity was evaluated using the Total Neuropathy Score, which is validated for CKD and DKD. 11 Total neuropathy scores range from 0 to 32 and a higher score is indicative of more severe neuropathy while a score of zero indicates an absence of neuropathy. Sural, tibial, and median nerve conduction studies were done according to established protocols.…”

Section: Methodsmentioning

confidence: 99%

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

et al. 2022

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Introduction/Aims: Sonographic alterations of peripheral nerves in pre-dialytic kidney disease are yet to be determined. We aimed to assess peripheral nerve crosssectional area (CSA) and intraneural blood flow in patients with pre-dialytic chronic kidney disease (CKD) and diabetic kidney disease (DKD).Methods: Subjects with CKD (n = 20) or DKD (n = 20) underwent ultrasound to assess CSA of the median and tibial nerves as well as intraneural blood flow of the median nerve. Blood flow was quantified using maximum perfusion intensity. Neuropathy was assessed using the Total Neuropathy Score. A 6-m timed walk test was also performed. Healthy controls (n = 28) were recruited for comparison. Results:The DKD group had more severe neuropathy (p = .024), larger tibial nerve CSA (p = .002) and greater median nerve blood flow than the CKD group (p = .023).Blood flow correlated with serum potassium in disease groups (r = 0.652, p = .022).Disease groups had larger tibial nerve CSA than controls (p < .05). No blood flow was detected in controls. Tibial nerve enlargement was associated with slower maximal walking speeds in disease groups (r = À0.389, p = .021).Discussion: Subjects with DKD demonstrated enlarged tibial nerve CSA and increased median nerve blood flow compared to those with CKD. Elevations in serum potassium were associated with increased blood flow. Sonographic alterations were detectable in pre-dialytic kidney disease compared to controls, highlighting the utility of ultrasound in the assessment of nerve pathology in these patient groups.

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“…The primary outcome will be assessed by modified Total Neuropathy Score (TNS). TNS is a measure of peripheral polyneuropathy, is validated in diabetic and chemotherapy-induced neuropathy21 and, in line with the consensus statement of the American Academy of Neurology for neuropathy assessment in research, includes symptoms, signs and electrophysiological findings 22. It combines a structured symptom questionnaire (0–8 points), neurological examination signs (0–12 points) and tibial and sural nerve sensory amplitudes on NCS (0–8 points), to provide a score of 0 to 28.…”

Section: Methodsmentioning

confidence: 99%

Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol

et al. 2019

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IntroductionThe majority of patients undergoing haemodialysis (HD) show evidence of uraemic neuropathy, a condition with no known disease-modifying treatments. The pathogenesis of uraemic neuropathy is poorly understood, but may be related to cumulative exposure to middle molecules or other solutes such as potassium. It is not known whether haemodiafiltration (HDF) reduces the progression of uraemic neuropathy.Methods and analysisFiltration In the Neuropathy of End-Stage kidney disease Symptom Evolution (FINESSE) is a multicentre, randomised, open-label, blinded endpoint assessment, controlled trial designed to assess the impact of HDF versus HD on uraemic neuropathy. Maintenance HD patients will be randomised in a 1:1 ratio to receive HDF or HD with high-flux membranes for 4 years. The primary endpoint is the difference in the mean change in Total Neuropathy Score (TNS)—a measure of peripheral neuropathy combining symptoms, signs and nerve conduction velocity—over the study period. Secondary outcomes include change at annual timepoints in the TNS and the Neuropathy Symptom Score; and in morbidity, mortality and safety events.Ethics and disseminationThe FINESSE trial has been approved by the Ethics Review Committee of the Sydney South West Area Health Service (HREC/09/RPAH/268) and of Adventist HealthCare Limited (2012–027). When published in a peer-reviewed journal, it will be the largest and longest reported randomised trial aimed at reducing the incidence and severity of uraemic neuropathy. It will advance the understanding of the natural history of uraemic neuropathy and the influence of convective therapies on both neurophysiological and clinical outcomes. It will also allow refinement of current hypotheses surrounding the pathogenesis of uraemic neuropathy and, most importantly, may lead to improvements in the lives of the many patients affected by this debilitating condition.Trial registration numberACTRN12609000615280.

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The utility of the Total Neuropathy Score as an instrument to assess neuropathy severity in chronic kidney disease: A validation study

Abstract: The TNS is the first neuropathy scale to be formally validated in patients with CKD.

Cited by 15 publications

References 19 publications

Comparing neuropathy in multiple myeloma and AL amyloidosis

Comparing neuropathy in multiple myeloma and AL amyloidosis

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol

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