Chronic renal failure is one of the common causes for peripheral neuropathy. In this article, the authors summarize the clinical, electrophysiological, and pathological features of uremic neuropathy. Prevention and treatment of uremic neuropathy focus on dialysis and renal transplantation.
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• Uremic neuropathy is a distal sensorimotor polyneuropathy caused by uremic toxins.
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• Symptoms are insidious in onset. Paresthesias are usually the earliest symptoms; weakness and atrophy will follow the sensory symptoms.
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• The pathologic features are severe axonal degeneration in the most distal nerve trunks with secondary segmental demyelination.
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• Chronic dialysis may prevent neuropathy in some patients, especially if begun early. Renal transplantation is generally the most successful method to prevent neuropathy.
Historical note and terminology
Uremic neuropathy is a distal sensorimotor polyneuropathy caused by uremic toxins. It is considered a dying-back neuropathy, or central-peripheral axonopathy, associated with secondary demyelination. Its existence was suspected by Charcot in 1880 (14) and Osler in 1892 (56). Since the introduction of hemodialysis and renal transplantation in early 1960s, uremic neuropathy has been thoroughly investigated. Before then there were only scant reports of an association between chronic renal failure and polyneuropathy, and its nature was unclear. In 1961, the cases of 2 young men with hereditary interstitial nephritis, nerve deafness, and polyneuropathy were reported (50). Asbury, Victor, and Adams described the clinical and pathological features in detail (04; 05). Dyck and colleagues established the current concept of uremic neuropathy based on nerve conduction studies and light and electron microscopy studies (20). Using quantitative histology, they demonstrated axonal shrinkage. Myelin sheaths appeared to be affected out of proportion to axons. Neuronal rather than axonal dysfunction appeared to result in reduced axonal diameter, myelin rearrangement, and finally, complete degeneration of the axon (20). Nielsen published numerous papers in clinical and electrophysiologic studies in the 1970s (52; 53). These descriptions have not changed significantly over time. The greatest strides have been in the documentation of the therapeutic effects of dialysis and renal transplantation on the peripheral neuropathy (69; 53; 29; 75).