KDOQI GUIDELINE 11. ASSOCIATION OF LEVEL OF GFR WITH NEUROPATHY.doc

KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification PART 6. ASSOCIATION OF LEVEL OF GFR WITH COMPLICATIONS IN ADULTS GUIDELINE 11. ASSOCIATION OF LEVEL OF GFR WITH NEUROPATHY Neuropathy develops during the course of chronic kidney disease and may become symptomatic. Patients with chronic kidney disease should be periodically assessed for central and peripheral neurologic involvement by eliciting symptoms and signs during routine office visits or exams. Specialized laboratory testing for neuropathy in patients with chronic kidney disease is indicated only in the presence of symptoms. BACKGROUND Neuropathy is a common complication of patients with kidney failure.438-440 Neuropathy may be manifested as encephalopathy, peripheral polyneuropathy, autonomic dysfunction, sleep disorders, and, less commonly, peripheral mononeuropathy. Occurrence of neuropathy is related to the level of kidney function, but not the type of kidney disease. However, there are certain causes of chronic kidney disease that also affect the central and/or peripheral nervous system. These are amyloidosis, diabetes, systemic lupus erythematosus, polyarteritis nodosa, and hepatic failure.438,439 In addition, there are congenital disorders that affect both the kidneys and nervous system, such as Von Hippel Lindau disease, Wilsons disease, and Fabrys disease.438 The pathophysiology of uremic neuropathy is not well understood. Levels of urea, creatinine, PTH, middle molecules, and others have been correlated with reduction of nerve conduction velocity (NCV) and peripheral manifestations of neuropathy.438,439 In advanced stages there is evidence of histopathological damage with axonal degeneration and secondary demyelination of peripheral nerves.438 RATIONALE Markers of Neuropathy Uremic neuropathy may affect the central, peripheral, or autonomic nervous systems. Early uremic encephalopathy may present with fatigue, impaired memory, or concentra