- 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
Uremic polyneuropathy is common among patients with end-stage renal disease (ESRD) [1-3]. Polyneuropathy generally develops only in patients with significantly reduced glomerular filtration rate (GFR) and is an indication to initiate dialysis. However, patients already being adequately dialyzed may also develop polyneuropathy, although, among such patients, the polyneuropathy is often subclinical and detectable only by electrophysiologic studies.
This topic reviews uremic polyneuropathy. Uremic mononeuropathy, restless leg syndrome, and other neurologic manifestations associated with uremia or dialysis are discussed elsewhere. (See "Uremic mononeuropathy" and "Seizures in patients undergoing hemodialysis", section on 'Uremic encephalopathy' and "Sleep disorders in end-stage renal disease", section on 'Restless legs syndrome and periodic limb movement disorder'.)
PATHOLOGY AND PATHOGENESIS
Uremic polyneuropathy is a distal, symmetrical, mixed sensorimotor neuropathy that is characterized by demyelination and axonal degeneration . Axonal degeneration appears to be the primary abnormality and results in secondary segmental demyelination. These changes are most severe distally, and longer axons are affected first. In addition to peripheral nerve involvement, demyelination of the posterior columns and other portions of the central nervous system has also been described .
The cause of uremic polyneuropathy is not known . Factors that have been suggested to contribute include deficiencies of thiamine, zinc, and biotin and decreased transketolase activity . Increases in phenols, myoinositol, beta2-microglobulin and other middle molecular weight substances, and hyperparathyroidism have also been suggested to contribute [5-7].
Uremic polyneuropathy is common among dialysis and nondialysis chronic kidney disease (CKD) patients. Among dialysis patients, 60 to 100 percent of patients have electrophysiologic signs of impaired nerve function, although a lower percentage of patients are symptomatic [8-11].
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