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Uraemic Polyneuropathy Diagnosis — ESENeph MCQ

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ModerateChronic Kidney DiseaseUraemic Polyneuropathy DiagnosisESENeph

A 60-year-old man with CKD G4 develops peripheral neuropathy. Nerve conduction studies show a symmetrical sensorimotor axonal polyneuropathy. His B12, folate, glucose, and thyroid function are normal. He has been on dialysis for 6 months. What is the most likely cause?

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Correct answer: E — Uraemic polyneuropathy – a length-dependent axonal neuropathy caused by accumulation of uraemic neurotoxins; it typically improves with adequate dialysis and resolves after kidney transplantation

Uraemic polyneuropathy is a common complication of CKD G5/ESKD, affecting up to 60-90% of dialysis patients to some degree. It is caused by accumulation of middle molecular weight uraemic toxins (including beta-2 microglobulin, p-cresyl sulphate, and others) that are neurotoxic. The pattern is typically symmetrical, distal, sensorimotor, and axonal – affecting legs before arms (length-dependent). Intensifying dialysis (longer sessions, HDF) may improve symptoms by enhancing middle molecule clearance. Kidney transplantation often leads to significant improvement. Gabapentin/Pregabalin can provide symptomatic relief but require renal dose adjustment.

Reference: ERA-EDTA 2019 – Neurological Complications; KDIGO 2024 – CKD