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Neuropsychiatric symptomatology with chronic renal insufficiency in the stage of compensated and decompensated retention

II. Peripheral nerve disturbances

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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.

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  1. Neurologische Klinik und Abteilung für klinische Nephrologie der I. Medizinischen Klinik der Fakultät für klinische Medizin Mannheim der Universität Heidelberg, Germany

    B. Neundörfer, C. Kayser-Gatchalian, W. Huber & W. Werner

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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

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