eMedicine Specialties > Neurology > Neurotoxicology

Uremic Neuropathy: Follow-up

Author: Yi Pan, MD, PhD, Assistant Professor, Department of Neurology, Saint Louis University Hospital
Contributor Information and Disclosures

Updated: Oct 11, 2006

Follow-up

Prognosis

  • Despite regular dialysis treatment, uremic neuropathy has been shown to progress, especially after 10 years and in the elderly. Renal transplantation can result in complete recovery from uremic neuropathy if the duration between the onset of neuropathy and transplantation is short.

Miscellaneous

Medicolegal Pitfalls

  • Failure to document neuropathy correctly
  • Failure to exclude other cause of polyneuropathy in chronic renal failure
  • Failure to adjust the dose of medication with renal function
  • Failure to prevent falls in patients with gait difficulty
 


More on Uremic Neuropathy

Overview: Uremic Neuropathy
Differential Diagnoses & Workup: Uremic Neuropathy
Treatment & Medication: Uremic Neuropathy
Follow-up: Uremic Neuropathy
Multimedia: Uremic Neuropathy
References
[ CLOSE WINDOW ]

References

  1. Angus-Leppan H, Burke D. The function of large and small nerve fibers in renal failure. Muscle Nerve. Mar 1992;15(3):288-94. [Medline].

  2. Asbury AK, Victor M, Adams RD. Uremic polyneuropathy. Arch Neurol. Apr 1963;8:413-28. [Medline].

  3. Asbury AK. Recovery from uremic neuropathy. N Engl J Med. May 27 1971;284(21):1211-2. [Medline].

  4. Bolton CF. Peripheral neuropathies associated with chronic renal failure. Can J Neurol Sci. May 1980;7(2):89-96. [Medline].

  5. Bolton CF. Chronic dialysis for uremia. N Engl J Med. Mar 27 1980;302(13):755. [Medline].

  6. Bolton CF, Young GB. Neurological Complications of Renal Disease. Stoneham, Mass:. Butterworth-Heinemann;1990:1-256.

  7. Bolton CF, McKeown MJ, Chen R, et al. Subacute uremic and diabetic polyneuropathy. Muscle Nerve. Jan 1997;20(1):59-64. [Medline].

  8. Bolton CF, Remtulla H, Toth B, et al. Distinctive electrophysiological features of denervated muscle in uremic patients. J Clin Neurophysiol. Nov 1997;14(6):539-42. [Medline].

  9. Braguer D, Gallice P, Yatzidis H, et al. Restoration by biotin of the in vitro microtubule formation inhibited by uremic toxins. Nephron. 1991;57(2):192-6. [Medline].

  10. Charcot JM. Lecons sur les maladies du systeme nerveux. XVI Des paraplegies urinares. 3rd ed. Paris:. 1880:295.

  11. Charra B, Calemard E, Uzan M, et al. Carpal tunnel syndrome, shoulder pain and amyloid deposits in long-term haemodialysis patients. Proc Eur Dial Transplant Assoc Eur Ren Assoc. 1985;21:291-5. [Medline].

  12. Chen QT. [Uremic neuropathy]. Zhonghua Shen Jing Jing Shen Ke Za Zhi. Feb 1989;22(1):35-6, 62-3. [Medline].

  13. Danziger CH. Uremic neuropathy and treatment with renal transplantation. ANNA J. Apr 1989;16(2):67-70. [Medline].

  14. Dhondt A, Vanholder R, Van Biesen W, et al. The removal of uremic toxins. Kidney Int. Aug 2000;58 Suppl 76:S47-59. [Medline].

  15. Djukanovic LJ, Mimic-Oka JI, Potic JB. The effects of hemodialysis with different membranes on middle molecules and uremic neuropathy. Int J Artif Organs. Jan 1989;12(1):11-9. [Medline].

  16. Dyck PJ, Johnson WJ, Lambert EH, et al. Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin Proc. Jun 1971;46(6):400-31. [Medline].

  17. Dyck PJ, Johnson WJ, Lambert EH, et al. Comparison of symptoms, chemistry, and nerve function to assess adequacy of hemodialysis. Neurology. Oct 1979;29(10):1361-8. [Medline].

  18. Fraser CL, Arieff AI. Nervous system complications in uremia. Ann Intern Med. Jul 15 1988;109(2):143-53. [Medline].

  19. Hassan K, Simri W, Rubenchik I, et al. Effect of erythropoietin therapy on polyneuropathy in predialytic patients. J Nephrol. Jan-Feb 2003;16(1):121-5. [Medline].

  20. Hassan K, Amir S, Michael S, et al. Electrophysiological abnormalities in upper extremities after brachiocephalic A-V fistulas construction in predialysis patients. Ren Fail. Mar 2004;26(2):111-7. [Medline].

  21. Hupperts RM, Leunissen KM, van Hooff JP, et al. Recovery of uremic neuropathy after renal transplantation. Clin Neurol Neurosurg. 1990;92(1):87-9. [Medline].

  22. Jurcic D, Bago J, Eljuga D, et al. Features of uremic neuropathy in long-term dialysis. Coll Antropol. Jun 1998;22(1):119-25. [Medline].

  23. Lynch PG, Yuill GM, Nicholson JA. Acute polyneuropathy complicating chronic renal failure. Nephron. 1971;8(3):278-88. [Medline].

  24. Makita Z, Bucala R, Rayfield EJ, et al. Reactive glycosylation endproducts in diabetic uraemia and treatment of renal failure. Lancet. Jun 18 1994;343(8912):1519-22. [Medline].

  25. Manenti L, Vaglio A, Costantino E, et al. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. J Nephrol. Jan-Feb 2005;18(1):86-91. [Medline].

  26. Marra TR. Proximal vs. distal nerve conduction measurements in uremic neuropathy. Electromyogr Clin Neurophysiol. Nov-Dec 1988;28(7-8):439-43. [Medline].

  27. Mitch WE. Dietary therapy in uremia: the impact on nutrition and progressive renal failure. Kidney Int. Apr 2000;57 Suppl 75:S38-43. [Medline].

  28. Nielsen VK. Recovery from peripheral neuropathy after renal transplantation. Acta Neurol Scand. 1970;46:Suppl 43:207+. [Medline].

  29. Nielsen VK, Winkel P. The peripheral nerve function in chronic renal failure. 3. A multivariate statistical analysis of factors presumed to affect the development of clinical neuropathy. Acta Med Scand. Jul-Aug 1971;190(1-2):119-25. [Medline].

  30. Nielsen VK. The peripheral nerve function in chronic renal failure. II. Intercorrelation of clinical symptoms and signs and clinical grading of neuropathy. Acta Med Scand. Jul-Aug 1971;190(1-2):113-7. [Medline].

  31. Nielsen VK. The peripheral nerve function in chronic renal failure. I. Clinical symptoms and signs. Acta Med Scand. Jul-Aug 1971;190(1-2):105-11. [Medline].

  32. Nielsen VK. The peripheral nerve function in chronic renal failure. IV. An analysis of the vibratory perception threshold. Acta Med Scand. Apr 1972;191(4):287-96. [Medline].

  33. Nielsen VK. The peripheral nerve function in chronic renal failure. VI. The relationship betweeen sensory and motor nerve conduction and kidney function, azotemia, age, sex, and clinical neuropathy. Acta Med Scand. Nov 1973;194(5):455-62. [Medline].

  34. Nielsen VK. The peripheral nerve function in chronic renal failure. V. Sensory and motor conduction velocity. Acta Med Scand. Nov 1973;194(5):445-54. [Medline].

  35. Nielsen VK. Sensory and motor nerve conduction in the median nerve in normal subjects. Acta Med Scand. Nov 1973;194(5):435-43. [Medline].

  36. Nielsen VK. The peripheral nerve function in chronic renal failure. X. Decremental nerve conduction in uremia?. Acta Med Scand. Jul-Aug 1974;196(1-2):83-6. [Medline].

  37. Nielsen VK. The peripheral nerve function in chronic renal failure. IX. Recovery after renal transplantation. Electrophysiological aspects (sensory and motor nerve conduction). Acta Med Scand. Mar 1974;195(3):171-80. [Medline].

  38. Nielsen VK. The peripheral nerve function in chronic renal failure. VII. Longitudinal course during terminal renal failure and regular hemodialysis. Acta Med Scand. Mar 1974;195(3):155-62. [Medline].

  39. Nielsen VK. The peripheral nerve function in chronic renal failure. 8. Recovery after renal transplantation. Clinical aspects. Acta Med Scand. Mar 1974;195(3):163-70. [Medline].

  40. Osler W. The Principles and Practice of Medicine. 7th ed. London:. Appleton & Lange;1892:684, 699.

  41. Panayiotopoulos CP, Lagos G. Tibial nerve H-reflex and F-wave studies in patients with uremic neuropathy. Muscle Nerve. Sep-Oct 1980;3(5):423-6. [Medline].

  42. Ropper AH. Accelerated neuropathy of renal failure. Arch Neurol. May 1993;50(5):536-9. [Medline].

  43. Siamopoulos KC, Tsianos EV, Dardamanis M, et al. Esophageal dysfunction in chronic hemodialysis patients. Nephron. 1990;55(4):389-93. [Medline].

  44. Spencer PS, Sabri MI, Schaumburg HH, et al. Does a defect of energy metabolism in the nerve fiber underlie axonal degeneration in polyneuropathies?. Ann Neurol. Jun 1979;5(6):501-7. [Medline].

  45. Tegner R, Lindholm B. Uremic polyneuropathy: different effects of hemodialysis and continuous ambulatory peritoneal dialysis. Acta Med Scand. 1985;218(4):409-16. [Medline].

  46. Thomas PK. Screening for peripheral neuropathy in patients treated by chronic hemodialysis. Muscle Nerve. Sep-Oct 1978;1(5):396-9. [Medline].

  47. Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis. Sep 1996;28(3):372-8. [Medline].

  48. Yatzidis H, Koutsicos D, Agroyannis B, et al. Biotin in the management of uremic neurologic disorders. Nephron. 1984;36(3):183-6. [Medline].

  49. Yildiz A, Sever MS, Demirel S, et al. Improvement of uremic autonomic dysfunction after renal transplantation: a heart rate variability study. Nephron. Sep 1998;80(1):57-60. [Medline].

  50. Yosipovitch G, Yarnitsky D, Mermelstein V, et al. Paradoxical heat sensation in uremic polyneuropathy. Muscle Nerve. Jul 1995;18(7):768-71. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

kidney failure, renal insufficiency, renal failure, uremia, distal sensorimotor polyneuropathy, uremic toxins, dying-back neuropathy, central-peripheral axonopathy associated with secondary demyelination

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Yi Pan, MD, PhD, Assistant Professor, Department of Neurology, Saint Louis University Hospital
Yi Pan, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Physiological Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

J Stephen Huff, MD, Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Associate Program Director, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.