Proximal muscle weakness in uremia. Case reports and review of the literature
R. P. Lazaro and H. S. Kirshner
Weakness of the proximal muscle groups developed in six uremic patients,
five men and one woman, while receiving hemodialysis. All showed
roentgenographic evidence of renal osteodystrophy. Partial to complete
recovery of strength followed subtotal parathyroidectomy in four patients.
All patients had normal levels of creatine phosphokinase. Electrodiagnostic
testing showed features of both "myopathic" and denervating processes on
coaxial needle exploration and normal to slowed nerve conduction. Muscle
biopsy specimens in four patients showed type 2 fiber atrophy with no
evidence of necrosis, phagocytosis, regeneration, or vasculitis. The
pathogenesis of proximal muscle weakness in uremia is uncertain but may be
related to secondary hyperparathyroidism or osteodystrophy.
