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Uremic mononeuropathy

Biff F Palmer, MD
William L Henrich, MD, MACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Clinically apparent mononeuropathies are common in patients with end-stage renal disease (ESRD) [1]. 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".)


Among end-stage renal disease (ESRD) patients, mononeuropathies are generally caused by compression, local ischemia, or infiltration by amyloid fibrils composed of beta2-microglobulin [2]. 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 [4]. 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 [1].

Perhaps the most common cause of CTS among dialysis patients is dialysis-related amyloidosis [5]. (See "Dialysis-related amyloidosis", section on 'Clinical manifestations'.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 19, 2016.
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