Peripheral neuropathy in patients with chronic renal failure. A treatable source of discomfort and disability.

Uremic polyneuropathy occurs in about half of patients undergoing dialysis and is characterized by axonal degeneration with secondary segmental demyelination. Hemodialysis or peritoneal dialysis halts the progress of polyneuropathy but usually does not bring improvement. However, improvement invariably occurs with successful renal transplantation. Mononeuropathies resulting from placement of forearm arteriovenous fistulas are also seen and include the commonly encountered carpal tunnel syndrome and the rare but catastrophic ischemic monomelic neuropathy. The latter constitutes a medical emergency; immediate surgical closure of the fistula is required to avoid severe and permanent neurologic dysfunction.