Accelerated neuropathy of renal failure
A. H. Ropper
Neurology Service, St Elizabeth's Hospital, Boston, Mass 02135.
OBJECTIVE--To describe a syndrome of rapidly evolving polyneuropathy in
patients with severe renal failure. DESIGN--Retrospective case series of
four patients. SETTING--In-hospital evaluations and personal examinations
of patients. PATIENTS--Four patients with severe or end-stage renal failure
who were receiving peritoneal dialysis. RESULTS--These patients had an
acute or subacute syndrome characterized by generalized limb weakness over
days or weeks, severe imbalance, diminished reflexes, and numbness. Spinal
fluid protein levels were elevated and some demyelinating features were
noted on electrophysiological testing. Improvement occurred with more
frequent peritoneal dialysis in one patient and transplantation in another,
but the neuropathy progressed in the other two in whom diabetes may have
played a role. CONCLUSION--This partly reversible acute uremic neuropathy,
which is probably caused by the metabolic disturbances of end-stage renal
failure, simulates Guillain-Barre syndrome or chronic inflammatory
demyelinating polyneuropathy and may be complicated by diabetic neuropathy.
