- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
Clinically apparent mononeuropathies are common in patients with end-stage renal disease (ESRD) . The most commonly observed mononeuropathy among such patients is carpal tunnel syndrome (CTS), although other mononeuropathies involving the ulnar nerve, femoral, and cranial nerves may also occur.
This topic reviews uremic mononeuropathy. Polyneuropathies associated with ESRD are discussed elsewhere (see "Uremic polyneuropathy"). Dialysis-related amyloidosis is discussed elsewhere. (See "Dialysis-related amyloidosis".)
OVERVIEW AND TYPES
Among end-stage renal disease (ESRD) patients, mononeuropathies are generally caused by compression, local ischemia, or infiltration by amyloid fibrils composed of beta2-microglobulin . Carpal tunnel syndrome (CTS) involving the median nerve is the most common mononeuropathy observed in ESRD patients. Other mononeuropathies that may be seen include ulnar neuropathy, femoral neuropathy, and, less commonly, radial neuropathy, cranial nerve neuropathy, and optic nerve neuropathy [2,3]. Acute ischemic monomelic neuropathy (IMN) is a rare neuropathy that results from placement of the hemodialysis access . IMN is not a classic mononeuropathy, since it often affects multiple nerves (radial ulnar and medial nerves). (See 'Acute ischemic monomelic neuropathy' below.)
Carpal tunnel syndrome — CTS is the most common mononeuropathy in dialysis patients, with a reported prevalence of 6 to 31 percent .
Perhaps the most common cause of CTS among dialysis patients is dialysis-related amyloidosis . (See "Dialysis-related amyloidosis", section on 'Clinical manifestations'.)
- Krishnan AV, Kiernan MC. Uremic neuropathy: clinical features and new pathophysiological insights. Muscle Nerve 2007; 35:273.
- Bansal VK, Bansal S. Nervous system disorders in dialysis patients. Handb Clin Neurol 2014; 119:395.
- Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg 2004; 107:1.
- Thermann F, Kornhuber M. Ischemic monomelic neuropathy: a rare but important complication after hemodialysis access placement--a review. J Vasc Access 2011; 12:113.
- Bicknell JM, Lim AC, Raroque HG Jr, Tzamaloukas AH. Carpal tunnel syndrome, subclinical median mononeuropathy, and peripheral polyneuropathy: common early complications of chronic peritoneal dialysis and hemodialysis. Arch Phys Med Rehabil 1991; 72:378.
- Gousheh J, Iranpour A. Association between carpel tunnel syndrome and arteriovenous fistula in hemodialysis patients. Plast Reconstr Surg 2005; 116:508.
- Delmez JA, Holtmann B, Sicard GA, et al. Peripheral nerve entrapment syndromes in chronic hemodialysis patients. Nephron 1982; 30:118.
- Kimura I, Sekino H, Ayyar DR, et al. Carpal tunnel syndrome in patients on long-term hemodialysis. Tohoku J Exp Med 1986; 148:257.
- Cofan F, Garcia S, Combalia A, et al. Carpal tunnel syndrome secondary to uraemic tumoral calcinosis. Rheumatology (Oxford) 2002; 41:701.
- Reese GN, Appel SH. Neurologic complications of renal failure. Semin Nephrol 1981; 1:137.
- Nardin R, Chapman KM, Raynor EM. Prevalence of ulnar neuropathy in patients receiving hemodialysis. Arch Neurol 2005; 62:271.
- García S, Cofán F, Combalia A, et al. Compression of the ulnar nerve in Guyon's canal by uremic tumoral calcinosis. Arch Orthop Trauma Surg 2000; 120:228.
- Kalita J, Misra UK, Sharma RK, Rai P. Femoral and radial neuropathy following vascular access cannulation for hemodialysis. Nephron 1995; 69:362.
- Sharma KR, Cross J, Santiago F, et al. Incidence of acute femoral neuropathy following renal transplantation. Arch Neurol 2002; 59:541.
- Meech PR. Femoral neuropathy following renal transplantation. Aust N Z J Surg 1990; 60:117.
- Vaziri ND, Barton CH, Ravikumar GR, et al. Femoral neuropathy: a complication of renal transplantation. Nephron 1981; 28:30.
- Anteunis LJ, Mooy JM. Hearing loss in a uraemic patient: indications of involvement of the VIIIth nerve. J Laryngol Otol 1987; 101:492.
- Haider S, Astbury NJ, Hamilton DV. Optic neuropathy in uraemic patients on dialysis. Eye (Lond) 1993; 7 ( Pt 1):148.
- Seo JW, Jeon DH, Kang Y, et al. A case of end-stage renal disease initially manifested with visual loss caused by uremic optic neuropathy. Hemodial Int 2011; 15:395.