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Uraemic Peripheral Neuropathy Axonal Pattern — ESENeph MCQ

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HardChronic Kidney DiseaseUraemic Peripheral Neuropathy Axonal PatternESENeph

A patient with CKD G5 not yet receiving dialysis has progressive distal sensorimotor neuropathy, anorexia and impaired concentration attributed to uraemia. Potassium and volume status remain controlled. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Initiate planned dialysis for clinically significant uraemic symptoms

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

C is correct. NICE advises starting dialysis according to the impact of uraemic symptoms or biochemical abnormalities on daily living, or for uncontrollable fluid overload; an eGFR around 5–7 mL/min/1.73m² is a guide when symptoms are absent. Progressive uraemic neuropathy, anorexia and cognitive impairment are clinically important even with controlled potassium and volume. Symptom treatment alone does not remove uraemic toxins. The diagnosis should still be reviewed for diabetes, nutritional deficiency and paraproteinaemia, but a rigid eGFR threshold should not postpone modality planning and treatment in symptomatic kidney failure.

Reference: NICE NG107: renal replacement therapy and conservative management: https://www.nice.org.uk/guidance/ng107/chapter/Recommendations