Summary
80 strictly selected patients with chronic renal insufficiency with plasma creatinine values of 1.4–14.5 mg% were examined for clinical and electrophysiological signs of nephrogenic polyneuropathy. The motor symptoms complained of were cramps in 43.8% of the patients, “restless legs” in 18.7%, muscular twitchings in 12.5%. It was emphasized that the first two symptoms do not always indicate the presence of polyneuropathy. 30% complained of paresthesias, 5% of “burning feet”. The most frequent clinical finding was the impairment of vibration sense in the feet in 37.5% followed by diminished appreciation of passive movement of the toes in 30%, weakening or absence of the ankle jerk in 23.8% and finally, weakening of the patellar reflex in 5%. Slowing of motor conduction velocity of the lateral popliteal nerve was observed 11 times with values below 40 m/sec and of the median nerve, 14 times with values below 50 m/sec.
20 of 46 patients with plasma creatinine levels below 5 mg% had initial signs of neuropathy while 10 of 34 patients with levels above 5 mg% had no symptoms or signs of neuropathy at all. The clinical signs of neuropathy showed no statistically significant correlation with the CNS disturbances nor with the internal medical data. However, statistically significant correlations were found between the motor conduction velocity of the lateral popliteal nerve and the plasma creatinine and BUN level as well as the occurence of EEG changes. These results and their possible consequences are discussed in the light of the recent literature. The importance of dietetic management as a form of therapy is pointed out.
Zusammenfassung
80 Patienten aus einem streng selektierten Krankengut mit chronischer Niereninsuffizienz mit Serumkreatininwerten von 1,4–14,5 mg% wurden nach auf eine nephrogene Polyneuropathie hinweisende Symptome klinisch sowie elektromyographisch und elektroneurographisch untersucht. Über motorische Reizerscheinungen mit Crampi klagten 43,8% der Patienten, über „restless legs“ 18,7% und über Muskelzuckungen 12,5%. Dabei wurde hervorgehoben, daß die beiden ersten Symptome nicht immer als Neuropathiezeichen gewertet werden können. Über Paraesthesien klagten 30%, über „burning feet“ lediglich 5%. Als häufigster klinischer Befund fand sich in 37,5% eine Störung des Vibrationsempfindens an den Füßen, dann folgten Störungen des Lageempfindens an den Zehen mit 30%, eine Minderung oder Aufhebung der ASR in 23,8% und eine Abschwächung der PSR mit 5%. Die motorische Nervenleitgeschwindigkeit des N. peronaeus mit Werten unter 40 m/sec war 11mal, die des N. medianus mit Werten unter 50 m/sec 14mal sicher verzögert.
22 von 46 Patienten mit Kreatininwerten unter 5 mg% hatten schon erste Zeichen einer Neuropathie, während immerhin noch 9 von 34 Patienten mit Serumkreatininwerten über 5 mg% keinerlei Hinweise auf eine Neuropathie boten. Die klinisch faßbaren Neuropathiesymptome zeigten weder statistisch gesicherte Beziehungen zu den zentralnervösen Störungen noch zu den internistischen Untersuchungsdaten. Dagegen fanden sich statistisch gesicherte Beziehungen der motorischen Nervenleitgeschwindigkeit des N. peronaeus zu dem Serumspiegel von Kreatinin und Harnstoff sowie zum Auftreten von EEG-Veränderungen. Die sich daraus ergebenden Konsequenzen werden im Lichte der einschlägigen Literatur diskutiert. Auf die strenge diätetische Führung als Therapieprinzip wird hingewiesen.
Similar content being viewed by others
References
Appenzeller, O., Kornfeld, M., Albuquerque, N. M., MacGee, J.: Neuropathy in chronic renal disease. A microscopic, ultrastructural, and biochemical study of sural nerve biopsies. Arch. Neurol. 24, 449–461 (1971)
Asbury, A. K., Victor, M., Adams, R. D.: Uremic polyneuropathy. Trans. Amer. neurol. Ass. 87, 100–103 (1962)
Asbury, A. K.: Peripheral neuropathy due to nitrofurantoin. Lancet 1963 I, 334–335
Asbury, A. K., Victor, M., Adams, R. D.: Uremic polyneuropathy. Arch. Neurol. 8, 413–428 (1963)
Barber, N. D., Nakamoto, S., McCormack, L. J., Kolff, W. J.: Pathologic anatomy of 13 patients after prolonged periodic hemodialyses. Trans. Amer. Soc. Artif. intern. Org. 9, 21–28 (1963)
Bergström, J., Lindblom, U., Norée, L.-O.: Preservation of peripheral nerve function in severe uremia during treatment with low protein high calorie diet and surplus of essential amino acids. Acta neurol. scand. 51, 99–109 (1975)
Blagg, C. R., Kemble, F., Taverner, D.: Nerve conduction velocity in relationship to the severity of renal disease. Nephron 5, 290–299 (1968)
Bolton, Ch. F., Baltzan, M. A., Baltzan, R. B.: Effects of renal transplantation on uremic neuropathy. A clinical and electrophysiologic study. New Engl. J. Med. 284, 1170–1175 (1971)
Buchthal, F.: An introduction to electromyography. Kobenhagen: Scandinavian University Books, Gyldendal 1957
Burton, B. T.: Diet therapy in uremia. J. Diet. Ass. 54, 475–480 (1969)
Callaghan, N.: A study of peripheral nerve function in chronic renal failure. Irish J. med. Soc. 6, 325–331 (1966)
Callaghan, N.: Restless legs syndrome in uremic neuropathy. Neurology (Minneap.) 16, 359–361 (1966)
Case Records of the Massachusetts General Hospital: Case 42–1962: Presentation of case. New Engl. J. Med. 26, 1378 (1962)
Charcot, J. M.: Leçons sur les maladies du système nerveux faites à la salpétrière, 1870, 2ème série, 16ème leçon. A. Delahaye (ed.)
Christensen, N. J., Ørskov, H.: Vibratory perception during ischaemia in uraemic patients and in subjects with mild carbohydrate intolerance. J. Neurol. Neurosurg. Psychiat. 32, 519–524 (1969)
Clements, R. S., Jr., Cox, G. S.: Neuropathien urämischer Patienten. Die Myoinositol-Spiegel im Blut sind erhöht. Lancet 1973 I, 1137–1141
Dayan, A. D., Gardner-Thorpe, C., Down, P. F., Gleadle, R. I.: Peripheral neuropathy in uremia. Pathological studies on peripheral nerves from 6 patients. Neurology (Minneap.) 20, 649–658 (1970)
Dietz, V., Freund, H.-J.: Entladungsverhalten einzelner motorischer Einheiten bei urämischen Patienten. Ein Beitrag zur Frühdiagnose demyelinisierender Polyneuropathien. J. Neurol. 207, 255–269 (1974)
Dinapoli, R. P., Johnson, W. J.: Neurologic complications in chronic renal failure. Med. Clin. N. Amer. 52, 845–851 (1968)
Dinn, J. J., Crane, D. L.: Schwann cell dysfunction in uraemia. J. Neurol. Neurosurg. Psychiat. 33, 605–608 (1970)
Dobbelstein, H., Altmeyer, B., Edel, H., Gurland, H. J., Müller, R., Pichlmaier, H., Jabour, A.: Periphere Neuropathie bei chronischer Niereninsuffizienz, bei Dauerdialysebehandlung und nach Nierentransplantation. Med. Klin. 63, 616–622 (1968)
Dobbelstein, H., Edel, H. H., Schmidt, M., Schubert, G., Weinzierl, M.: Guanidinbernsteinsäure und Urämie. I. Mitteilung: Klinische Untersuchungen. Klin. Wschr. 49, 348–357 (1971)
Dobbelstein, H., Grunst, J., Schubert, G., Edel, H. H.: Guanidinbernsteinsäure und Urämie. II. Mitteilung: Tierexperimentelle Befunde. Klin. Wschr. 49, 1077–1083 (1971)
Dobbelstein, H.: Die urämische Neuropathie in Abhängigkeit von Dialysedauer und -gerät. Klin. Wschr. 50, 533–535 (1972)
Dobbelstein, H.: Neurologische Defekte durch Niereninsuffizienz. Urämische, langsam dialysable Toxine verursachen Schäden am peripheren Nervensystem. 80. Tagung d. Dtsch. Ges. Inn. Med., Wiesbaden, 21.–25. 4. 1974
Dyck, P. J., Johnson, W. J., Lambert, E. H., O'Brien, P. C.: Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin. Proc. 46, 400–431 (1971)
Fleming, L. W., Lenman, J. A. R., Stewart, W. K.: Effect of magnesium on nerve conduction velocity during regular dialysis treatment. J. Neurol. Neurosurg. Psychiat. 35, 342–355 (1972)
Forno, L., Alston, W.: Uremic polyneuropathy. Acta neurol. scand. 43, 640–654 (1967)
Funck-Brentano, J. L., Vantelon, J.: Les polynévrites des urémies chroniques traitées par hémodialyses répétées. 2. Intern. Kongr. Nephrol., Prag 1963, 173–175
Giovanetti, S., Balestri, L., Biagini, M., Menichini, G., Rindi, P.: Implications of dietary therapy. Arch. intern. Med. 126, 900–905 (1970)
Gonzalez, F. M., Pabico, R. C., Brown, H. W., Maher, J. F., Schreiner, G. E.: Further experience with the use of routine intermittent hemodialysis in chronic renal failure. Trans. Amer. Soc. Artif. intern. Org. 9, 11–20 (1963)
Hegstrom, R. M., Murray, J. S., Pendras, J. P., Burnell, J. M., Scribner, B. H.: Hemodialysis in the treatment of chronic uremia. Trans. Amer. Soc. Artif. intern. Org. 7, 136–152 (1961)
Hegstrom, R. M., Murray, J. S., Pendras, J. P., Burnell, J. M., Scribner, B. H.: Two year's experience with periodic hemodialysis in the treatment of chronic uremia. Trans. Amer. Soc. Artif. intern. Org. 8, 266–280 (1962)
Hollinrake, K., Thomas, P. K., Wills, M. R., Baillod, R. A.: Observations on plasma magnesium levels in patients with uremic neuropathy under treatment by periodic hemodialysis. Neurology (Minneap.) 20, 939–942 (1970)
Honet, J. C., Jebsen, R. H., Tenckhoff, H. A., McDonald, J. R.: Motor nerve conduction velocity in chronic renal insufficiency. Arch. phys. Med. 47, 647–652 (1966)
Ibrahim, M. M., Barnes, A. D., Crosland, J. M., Dawson-Edwards, P., Honigsberger, L., Newman, C. E., Robinson, B. H. B.: Effect of renal transplantation on uraemic neuropathy. Lancet 1974 II, 739
Jebsen, R. H., Tenckhoff, H., Honet, J. C.: Natural history of uremic polyneuropathy and effects of dialysis. New Engl. J. Med. 277, 327–333 (1967)
Jesus, P. V. de, Clements, R. S., Jr., Winegrad, A. I.: Hypermyoinositolemic polyneuropathy in rats. A possible mechanism for uremic polyneuropathy. J. neurol. Sci. 21, 237–249 (1974)
Konotey-Ahulu, F. I. D., Baillod, R., Comty, C. M., Heron, J. R., Shaldon, S., Thomas, P. K.: Effect of periodic dialysis on the peripheral neuropathy of end-stage renal failure. Brit. med. J. 1965 II, 1212–1215
Lindholm, D. D., Burnell, J. M., Murray, J. S.: Experience in the treatment of chronic uremia in an outpatient community hemodialysis center. Trans. Amer. Soc. Artif. intern. Org. 9, 3–10 (1963)
Lindholm, T.: The influence of uraemia and electrolyte disturbances on muscle action potentials and motor nerve conduction in man. Acta med. scand., Suppl. 491 (1968)
Locke, S., Merrill, J. P., Tyler, H. R.: Neurologic complications of acute uremia. Arch. intern. Med. 108, 519–530 (1961)
Mamoli, B., Kopsa, H., Gerstenbrand, F., Kotzaurek, R., Pateisky, K.: Zur Frage der urämischen Polyneuropathie nach Nierentransplantationen. J. Neurol. 208, 63–69 (1974)
Marin, O. S. M., Tyler, H. R.: Hereditary interstitial nephritis associated with polyneuropathy. Neurology (Minneap.) 11, 999–1005 (1961)
Mawdsley, C.: Metabolic disorders and the nervous system. Proc. roy. Soc. Med. 65, 871–874 (1972)
Murray, J. S., Pendras, J. P., Lindholm, D. D., Erickson, R. V.: Twenty-five months' experience in the treatment of chronic uremia at an outpatient community hemodialysis center. Trans. Amer. Soc. Artif. intern. Org. 10, 191–199 (1964)
Neundörfer, B.: Ein Beitrag zur Alkoholpolyneuropathie. Klinisches Bild sowie elektromyographische und elektroneurographische Untersuchungsergebnisse. Fortschr. Neurol. Psychiat. 40, 270–286 (1972)
Neundörfer, B., Adler, C.: Vergleichende elektroneurographische Untersuchungen mit Oberflächen- und Nadelelektroden. Z. EEG-EMG 3, 153–158 (1972)
Neundörfer, B.: Differentialtypologie der Polyneuritiden und Polyneuropathien. Schriftenreihe Neurologie, Bd. 11. Berlin-Heidelberg-New York: Springer 1973
Nielsen, V. K.: Sensory nerve conduction studies in uraemic patients. Proc. Europ. Dial. Transpl. Ass. 4, 279–284 (1967)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. I. Clinical symptoms and signs. Acta med. scand. 190, 105–111 (1971)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. II. Intercorrelation of clinical symptoms and signs and clinical grading of neuropathy. Acta med. scand. 190, 113–117 (1971)
Nielsen, V. K., Winkel, P.: The peripheral nerve function in chronic renal failure. III. A multivariante statistical analysis of factors presumed to affect the development of clinical neuropathy. Acta med. scand. 190, 119–125 (1971)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. IV. An analysis of the vibratory perception threshold. Acta med. scand. 191, 287–296 (1972)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. V. Sensory and motor conduction velocity. Acta med. scand. 194, 445–454 (1973)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. VI. The relationship between sensory and motor nerve conduction and kidney function, azotemia, age, sex, and clinical neuropathy. Acta med. scand. 194, 455–462 (1973)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. VII. Longitudinal course during terminal renal failure and regular hemodialysis. Acta med. scand. 195, 155–162 (1974)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. VIII. Recovery after renal transplantation. Clinical aspects. Acta med. scand. 195, 163–170 (1974)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. IX. Recovery after renal transplantation, electrophysiological aspects (sensory and motor nerve conduction). Acta med. scand. 195, 171–180 (1974)
Nielsen, V. K.: The peripheral nerve function in chronic renal failure. X. Decremental nerve conduction in uremia ? Acta med. scand. 196, 83–86 (1974)
Parkenberg, H., Nielsen, B., Larsen, N. A., Christoffersen, P.: Uremic polyneuropathy, clinical and pathological aspects. Z. Neurol. 200, 267–273 (1971)
Preswick, G., Jeremy, D.: Subclinical polyneuropathy in renal insufficiency. Lancet 1964 II, 731–732
Prill, A., Volles, E., Scheler, F., Quellhorst, E.: Verlaufsbeobachtungen neurologischer und hirnelektrischer Befunde bei chronischer Niereninsuffizienz und Dialysebehandlung. Verh. dtsch. Ges. inn. Med. 72, 609–613 (1967)
Prill, A.: Die neurologische Symptomatologie der akuten und chronischen Niereninsuffizienz. Schriftenreihe Neurologie, Bd. 2. Berlin-Heidelberg-New York: Springer 1969
Reichenmiller, H. E., Dürr, F., Bundschu, H. D.: Neurologic disorders in uremia. In: Uremia: An international conference on pathogenesis, diagnosis and therapy. Stuttgart: Thieme 1972
Riecker, G.: Encephalopathien als Folge von Elektrolytstörungen (unter besonderer Berücksichtigung der Niereninsuffizienz). Verh. dtsch. Ges. inn. Med. 72, 125–141 (1967)
Schupak, E., Merrill, J. P.: Experience with long-term intermittent hemodialysis. Ann. intern. Med. 62, 509–518 (1965)
Stewart, W. K., Fleming, L. W., Manuel, M. A.: Muscle cramps during maintenance haemodialysis. Lancet 1972 I, 1049–1051
Tackmann, W., Ullerich, D., Cremer, W., Lehmann, H. J.: Nerve conduction studies during the relative refractory period in sural nerves of patients with uremia. Europ. Neurol. 12, 331–339 (1974)
Tenckhoff, H. A., Boen, F. S. T., Jebsen, R. H., Spiegler, J. H.: Polyneuropathy in chronic renal insufficiency. J. Amer. med. Ass. 192, 1121–1124 (1965)
Tyler, H. R.: Neurological complications of dialysis, transplantation, and other forms of treatment in chronic uremia. Neurology (Minneap.) 15, 1081–1088 (1965)
Tyler, H. R., Gottlieb, A. A.: Peripheral neuropathy in uremia. Intern. Kongr. f. Neurol. 2, 351–356 (1965)
Tyler, H. R.: Neurologic disorders in renal failure. Amer. J. Med. 44, 734–748 (1968)
Tyler, H. R.: Neurologic disorders seen in the uremic patient. Arch. intern. Med. 126, 781–786 (1970)
Versaci, A. A., Olsen, K. J., McMain, P. B., Nakamoto, S., Kolff, W. J.: Uremic polyneuropathy: and motor nerve conduction velocities. Trans. Amer. Soc. Artif. intern. Org. 10, 328–331 (1964)
Wullen, F.: Zur Frage der urämischen Polyneuropathie. Med. Klin. 60, 840–843 (1965)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Neundörfer, B., Kayser-Gatchalian, C., Huber, W. et al. Neuropsychiatric symptomatology with chronic renal insufficiency in the stage of compensated and decompensated retention. J. Neurol. 211, 263–274 (1976). https://doi.org/10.1007/BF00313236
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00313236