Sensitivity of Ultrasound in Detection of Neuropathic Changes in Chronic Kidney Disease Patients

Abstract Background Neurological complications secondary to the uremic state, contribute largely to morbidity and mortality in patients with renal failure. The prevalence of peripheral neuropathy remains high in advanced renal dysfunction. Recently Sonographic alterations of peripheral nerves in chronic kidney disease disease have become a concern for early diagnosis of neuropathy in such patients hence decrease morbidity for these patients. The current study aims to investigate sensitivity of nerve ultra-sound in detection of uremic neuropathy in comparison to nerve conduction study. Objective To investigate the sensitivity of nerve US in detecting peripheral neuropathy by measuring CSA in CKD patients in comparison to nerve conduction velocity. Patients and Methods The present study is acase control study which was conducted at the Neurosonography unit in Ain Shams University Hospital, on patients of chronic kidney disease visiting outpatient nephrology clinic. We enrolled 30 patients (60 arms and legs) and 25 controls (50 arms and legs) in the study. The aim of our study to assess sensitivity of ultrasound in detection of neuropathic changes in CKD patients and to correlate the extent of nerve damage to renal dysfunction as measured by laboratory investigations. Results To the best of our knowledge, most recent studies that evaluated use of US in uremic neuropathy, focused on dialysis patients and including diabetic patients, most of these studies focused on carpal tunnel syndrome as a common comorbidity in end stage renal disease (ESRD) patients. Few studies evaluated the use of nerve ultrasound in CKD patients pre-dialysis, excluding other risk factors for neuropathy (like diabetes mellitus, autoimmune diseases, etc…) in comparison to nerve conduction studies. Conclusion Mean age of patients was 44 years with males constituting 53.3%% of the sample. The present study demonstrated increased cross-sectional area of nerves in uremic neuropathy by ultrasound. The results in our study showed that nerve ultrasound is a useful diagnostic tool for diagnosis of peripheral neuropathy in pre-dialytic chonic kidney disease patients. It was observed that normal CSA by US in the majority of nerves corresponded to normal NCS. Increased CSA was correlated to demylinating neuropathy more than axonal neuropathy. In axonal neuropathy, majority of nerves showed decreased CSA but normal and high CSA was found in nerves with axonal neuropathy.