Basturk Taner, Koc Yener, Kayalar Aarzu Ozdemir, Yilmaz Figen, Hasbal Nuri Baris, Sakaci Tamer, Ahbap Elbis, Unsal Abdulkadir
Associate Professor, Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Fellow, Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
J Clin Diagn Res. 2017 Jun;11(6):OC37-OC40. doi: 10.7860/JCDR/2017/24572.10101. Epub 2017 Jun 1.
Uremic polyneuropathy is very common among patients with Chronic Kidney Disease (CKD). The patients have electrophysiologic signs of impaired nerve function, although a lower percentage of patients are symptomatic. Electrophysiological parameters are quantitative indices of Polyneuropathy (PNP) severity.
To assess the frequency of PNP in patients on long term Peritoneal Dialysis (PD) treatment.
Twenty three PD patients were analysed, who were receiving dialysis for at least five years and the study population divided into two groups according to duration of PD treatment. Group 1 consisted of the patients who were dialysed for at least 10 years and Group 2 consisted of patients who were dialysed for five to nine years. Patients who switched from Haemodialysis (HD) to PD and patients with coexisting diseases that could lead to disturbances in nerve conduction were excluded from the study. PNP was diagnosed when slowing of Nerve Conduction Velocity (NCV) and/or lengthening of distal latencies and/or decrease in amplitude of muscle action potential were present in two or more nerves and longer F wave response was present in one or two nerves. Carpal Tunnel Syndrome (CTS) was diagnosed if slowing of NCV and/or decrease in amplitude of muscle action potential and/or lenghening of distal latency of either sensory or motor median nerve present.
PNP was observed in 17 of the patients {73.9%; Group 1 (n=10) and Group 2 (n=7)}. Mixed type sensory motor neuropathy was diagnosed in nine patients from Group 1 and five patients from Group 2; one patient from Group 1 had demyelinating PNP affecting motor and sensory nerves; one patient from Group 2 had axonal PNP affecting motor and sensory nerves. From Group 1, two patients had CTS related to PNP and one patient had CTS without PNP. The results of motor conductivity testing showed lower conduction velocity for left popliteal nerve in Group 1 and Group 2 patients (13.85±2.17 ms, 4.80±1.11 ms, p=0.01). In both groups, mean motor and sensory latency, amplitude and velocity of other nerves were not found to be significantly different (p>0.05).
PNP is a common complication in long term PD patients. Over five years of treatment, frequency of PNP and CTS do not increase with duration of dialysis.
尿毒症性多发性神经病在慢性肾脏病（CKD）患者中非常常见。尽管有症状的患者比例较低，但这些患者存在神经功能受损的电生理体征。电生理参数是多发性神经病（PNP）严重程度的定量指标。
评估长期接受腹膜透析（PD）治疗的患者中PNP的发生率。
分析了23例PD患者，他们接受透析至少5年，研究人群根据PD治疗时间分为两组。第1组由透析至少10年的患者组成，第2组由透析5至9年的患者组成。从血液透析（HD）转为PD的患者以及患有可能导致神经传导障碍的合并疾病的患者被排除在研究之外。当两条或更多神经出现神经传导速度（NCV）减慢和/或远端潜伏期延长和/或肌肉动作电位幅度降低，且一条或两条神经出现F波反应延长时，诊断为PNP。如果感觉或运动正中神经的NCV减慢和/或肌肉动作电位幅度降低和/或远端潜伏期延长，则诊断为腕管综合征（CTS）。
17例患者观察到PNP{73.9%；第1组（n = 10）和第2组（n = 7）}。第1组9例患者和第2组5例患者被诊断为混合型感觉运动神经病；第1组1例患者患有脱髓鞘性PNP，影响运动和感觉神经；第2组1例患者患有轴索性PNP，影响运动和感觉神经。第1组中，2例患者的CTS与PNP相关，1例患者的CTS与PNP无关。运动传导测试结果显示，第1组和第2组患者左腘神经的传导速度较低（13.85±2.17 ms，4.80±1.11 ms，p = 0.01）。在两组中，其他神经的平均运动和感觉潜伏期、幅度和速度均无显著差异（p>0.05）。
PNP是长期PD患者的常见并发症。经过五年的治疗，PNP和CTS的发生率不会随着透析时间的延长而增加。
