Document Detail

Skin denervation and its clinical significance in late-stage chronic kidney disease.
MedLine Citation:
PMID:  21320986     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To investigate the skin innervation and its clinical significance in late-stage chronic kidney disease (CKD).
DESIGN: Case series.
SETTING: National Taiwan University Hospital, Taipei, Taiwan. Patients  Forty consecutive nondiabetic patients with late-stage CKD (14 female and 26 male; mean [SD] age, 60.7 [12.3] years), including 2 cases with stage 3 CKD, 6 with stage 4 CKD, and 32 with stage 5 CKD, ie, end-stage kidney disease.
INTERVENTIONS: Clinical evaluation of neurological deficits, nerve conduction study, autonomic function tests, and a 3-mm-diameter skin biopsy specimen taken from the distal leg.
MAIN OUTCOME MEASURES: Quantitation of epidermal innervation, parameters of nerve conduction study, R-R interval variability, and sympathetic skin response.
RESULTS: Clinically, 21 patients (52.5%) were symptomatic with paresthesia over the limbs or autonomic symptoms. The intraepidermal nerve fiber (IENF) density was markedly reduced in patients with CKD compared with age- and sex-matched controls (mean [SD], 2.8 [2.0] vs 8.6 [2.8] fibers/mm; P < .001). Skin denervation was observed in 27 patients (67.5%). Fifteen patients (37.5%) had abnormalities on nerve conduction studies, and 29 patients (72.5%) had abnormal results on autonomic function tests. By analysis with multiple regression models, the IENF density was negatively correlated with the duration of renal disease (P = .02). Additionally, the R-R interval variability at rest was linearly correlated with the IENF density (P = .02) and the absence of sympathetic skin responses at the soles was associated with reduced IENF density (P = .03).
CONCLUSIONS: Small-fiber sensory and autonomic neuropathies constitute the major form of neuropathy in late-stage CKD. Furthermore, skin denervation was associated with the duration of renal disease.
Chi-Chao Chao; Vin-Cent Wu; Chun-Hsiang Tan; Yi-Mei Wang; Ming-Tsung Tseng; Pei-Chen Wu; Yea-Huey Lin; Whei-Min Lin; Kwan-Dun Wu; Sung-Tsang Hsieh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of neurology     Volume:  68     ISSN:  1538-3687     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-6     Citation Subset:  AIM; IM    
Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S Rd, Taipei 10002, Taiwan.
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