Neurophysiologic parameters and symptoms in chronic renal failure

Abstract

We studied: (1) the sensitivity of various neurophysiologic parameters in the diagnosis of uremic polyneuropathy, (2) the relationship between subjective symptoms and neurophysiologic parameters, and (3) the effect of a single hemodialysis on the neurophysiologic parameters in 21 patients undergoing hemodialysis. The following parameters were studied: sensory and motor nerve conduction, including F-wave parameters; vibration detection thresholds; and thermal thresholds. The clinical findings and subjective symptoms were studied using a standardized questionnaire. The most sensitive parameters in the diagnosis of uremic neuropathy were F-wave parameters from lower limbs, vibration detection thresholds from the feet, and the sural nerve sensory action potential amplitude. The nerves from the upper extremities on the side of the fistula should not be used in the diagnosis of uremic polyneuropathy due to numerous mild local nerve lesions. The positive neuropathic symptoms correlated with quantitative vibratory detection thresholds and sensory nerve conduction studies, especially the amplitude of the sensory nerve action potential in the sural nerve. We found no significant change in any of the neurophysiologic parameters following a single hemodialysis session.

A neurophysiological study of large- and small-diameter nerve fibers in the hands of hemodialysis patients

“…Neuropathological studies in patients with UP have demonstrated predominant axonal involvement with secondary segmental demyelination [7,8]. These studies are supported by neurophysiological examinations [9][10][11]. Routine neurophysiological nerve conduction studies (NCS) and needle examinations evaluate large-diameter myelinated fibers only and are insufficient to detect a dysfunction of small-diameter nerve fibers.…”

“…CSP is a complementary method to conventional NCS and is very useful in the study of small-diameter nerve fiber function. However, quantitative sensory testing of small and unmyelinated nerve fibers is not widely performed in neurophysiological units [10,[15][16][17].…”

Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients

“…These insights were provided through the use of novel nerve excitability techniques, a clinical method that enables indirect assessment of ion channels, pumps and exchangers that are involved in the process of nerve impulse conduction (8). These techniques have proven particularly useful in detecting changes in peripheral nerve function in patients with chronic kidney disease (CKD), with previous studies demonstrating prominent changes in CKD patients receiving renal replacement therapies (9,10), changes that are undetectable using routine nerve conduction studies (11). The present study was undertaken to investigate the mechanisms underlying neurotoxicity in patients receiving immunosuppressive treatment following renal transplantation.…”

Nerve excitability properties in lower‐limb motor axons: Evidence for a length‐dependent gradient

“…This is apparent with the metabolic neuropathies, particularly diabetic and uremic neuropathy. 5,16,17,35,36 This predilection of metabolic disorders to affect preferentially lower-limb nerves has been related to the fact that these nerves are longer, although the basis for such length-dependent involvement has yet to be clearly established. 1,36,50 Adapting nerve excitability techniques to assess lower-limb nerve function is therefore timely.…”