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A Microscopic, Ultrastructural, and Biochemical Study of Sural Nerve Biopsies

Otto Appenzeller, MD, PhD; Mario Kornfeld, MD; Joseph MacGee, PhD

Arch Neurol. 1971;24(5):449-461.

Abstract
Seven sural nerve biopsy specimens from patients with chronic uremia requiring dialysis were subjected to light and electron microscopy. Teased single fibers were examined for segmental demyelination and evidence of remyelination. Specimens were also examined by gas-liquid chromatography. Neuropathy is found histologically in patients without clinical peripheral nerve dysfunction, and the severity of pathological changes does not correlate with clinical or electrodiagnostic findings. Segmental demyelination, axon loss, wallerian degeneration, Schwann cell proliferation with formation of "onion bulbs," and remyelination were found. Gas-liquid chromatography showed significant differences in elution curves of sural nerves from patients with chronic renal disease when compared with those obtained from controls and patients with diabetic or alcoholic neuropathy. Clinical, pathological, and biochemical features suggest that neuropathy is, in part, caused by derangements in protein metabolism of Schwann cells.

Author Affiliations
Albuquerque, NM; Cincinnati

From the departments of neurology and medicine (Dr. Appenzeller) and pathology (Dr. Kornfeld), University of New Mexico Medical School, Albuquerque, NM, and the Medical Research Laboratories of the Veteran's Administration Hospital, and the departments of experimental medicine and biological chemistry, University of Cincinnati College of Medicine, Cincinnati (Dr. MacGee).

Footnotes
Accepted for publication Nov 25, 1970.

Reprint requests to Department of Neurology, University of New Mexico Medical School, Albuquerque, NM 87106 (Dr. Appenzeller).

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