A case of chronic renal failure associated with severe peripheral neuropathy

We report a case of chronic renal failure (CRF) associated with severe peripheral neuropathy developing in the course of maintenance hemodialysis (MHD) therapy, The patient, a 23-year-old man undergoing MHD therapy, showed severe muscular weakness with sensory deficit in the lower limbs. The muscula...

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Published in:	Nihon Jinzo Gakkai shi Vol. 28; no. 8; pp. 1161 - 1169
Main Authors:	ANDO, AKIRA, NAKAJIMA, AKIKATSU, HAMADA, MAKOTO, MIYAZAKI, RYOICHI, TOFUKU, YOHEI, TAKEDA, RYOYU, MATSUBARA, SIRO, FUKUHARA, NOBUYOSHI, TAKAMORI, MASAHARU, HORIGAMI, TAKEYUKI
Format:	Journal Article
Language:	Japanese
Published:	Japan Japanese Society of Nephrology 01-08-1986
Subjects:	Adult continious ambilatory peritoneal dialysis Diagnosis, Differential Humans idiopathic polyneuropathy Kidney Failure, Chronic - complications Male nerve biopsy Peripheral Nervous System Diseases - diagnosis Peripheral Nervous System Diseases - etiology Peripheral Nervous System Diseases - therapy Peritoneal Dialysis, Continuous Ambulatory Polyneuropathies - diagnosis Renal Dialysis - adverse effects Uremia - complications uremic polyneuropathy
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Summary:	We report a case of chronic renal failure (CRF) associated with severe peripheral neuropathy developing in the course of maintenance hemodialysis (MHD) therapy, The patient, a 23-year-old man undergoing MHD therapy, showed severe muscular weakness with sensory deficit in the lower limbs. The muscular weakness substantially disrupted the patient's dialy activities There was albuminocytologic dissociation in the cerebrospinal fluid, in spite of the increase of frequency of hemodialysis from twice to three times a week, patient's symptom worsened. Six months after the onset of the symptom, CAPD treatment was initiated, but no improvement of the neuropathy was found, the electromyographic examination disclosed a picture suggesting axonal degeneration, while the electric stimulation of median nerve elicited a response from the thenar muscle only with the stimulus given at the wrist, but none with stimuli delivered to the elbow and axilla levels. Findings suggested a primary lesion to be located in the proximal part of the motorneuron, the histological examination of the sural nerve disclosed changes of both demyelination and axonal degeneration. Based on these results, differentiation between idiopathic polyneuropathy and uremic polyneuropathy was impossible, because in the former demyelination of neuron is a morphological feature, while in the latter the characteristic finding is axonal degeneration. Three months after the aggressive treatment with a frequent exchange of CAPD dialysate, the muscular weakness was markedly improved, to extent that the patient could walk on crutches. The finding that aggressive CAPD treatment might be effective in the amelioration of neuropathy suggests that some uremic toxins might participate in the development of the symptom in this patient.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Report-3 ObjectType-Case Study-4
ISSN:	0385-2385 1884-0728
DOI:	10.14842/jpnjnephrol1959.28.1161