Autonomic and peripheral neuropathies in late stage CKD

January 01, 0001

Autonomic and peripheral neuropathies in late stage CKD

These Taiwanese authors investigated the skin innervation and its clinical significance in late-stage chronic kidney disease (CKD) in a case series including 40 consecutive nondiabetic patients with late-stage CKD (14 female and 26 male; mean age, 60.7 years), including 2 cases with stage 3 CKD, 6 with stage 4 CKD, and 32 with stage 5 CKD, ie, end-stage kidney disease. Clinical evaluation of neurological deficits, nerve conduction study, autonomic function tests, and a 3-mm-diameter skin biopsy specimen taken from the distal leg.

They found: "Clinically, 21 patients (52.5%) were symptomatic with paresthesia over the limbs or autonomic symptoms. The intraepidermal nerve fiber (IENF) density was markedly reduced in patients with CKD compared with age- and sex-matched controls (mean, 2.8 vs 8.6 fibers/mm). Skin denervation was observed in 27 patients (67.5%). Fifteen patients (37.5%) had abnormalities on nerve conduction studies, and 29 patients (72.5%) had abnormal results on autonomic function tests. By analysis with multiple regression models, the IENF density was negatively correlated with the duration of renal disease. Additionally, the R-R interval variability at rest was linearly correlated with the IENF density and the absence of sympathetic skin responses at the soles was associated with reduced IENF density."

The authors concluded: "Small-fiber sensory and autonomic neuropathies constitute the major form of neuropathy in late-stage CKD. Furthermore, skin denervation was associated with the duration of renal disease."

This study documents the association of neuropathies with CKD, a part of the natural history of this disease.

For the full abstract, click here.

Arch Neurol 68(2):200-206, February 2011 © 2011 to the American Medical Association
Skin Denervation and Its Clinical Significance in Late-Stage Chronic Kidney Disease. Chi-Chao Chao, Vin-Cent Wu, Chun-Hsiang Tan, et al. Correspondence to Dr. S Hsieh: [email protected]

Category: U. Urinary, N. Neurological. Keywords: chronic kidney disease, CKD, nondiabetic, autonomic neuropathy, peripheral neuropathy, case series, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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