Uremic Neuropathy
Nerve damage from advanced kidney failure
Quick Facts
- Type: Peripheral nerve disorder
- Cause: Advanced kidney failure and waste buildup
- Common symptoms: Numbness, tingling, restless legs, weakness
- Helped by: Dialysis and kidney transplantation
Overview
Uremic neuropathy is damage to the peripheral nerves that occurs in people with advanced kidney failure. When the kidneys can no longer filter the blood effectively, waste products and toxins accumulate, a state known as uremia. Over time, this buildup is thought to harm the nerves, leading to a polyneuropathy that usually affects both sides of the body and starts in the feet and legs.
The condition typically develops gradually as kidney function declines, and it is most common in people with chronic kidney disease who are approaching or receiving dialysis. Managing the underlying kidney disease, particularly through adequate dialysis or a kidney transplant, is the foundation of treatment and can stabilize or improve symptoms.
Symptoms
Symptoms usually begin in the feet and legs and progress slowly upward, affecting both sides fairly equally.
- Numbness and tingling in the feet and lower legs
- A burning or prickling sensation
- Restless legs and uncomfortable urges to move the legs, especially at night
- Muscle cramps
- Weakness, which tends to come later than the sensory symptoms
- Reduced sensation that can affect balance
Worsening weakness, difficulty walking, or new symptoms should be reported, as they may reflect progression of kidney disease or another problem.
Causes
Uremic neuropathy is caused by the effects of advanced kidney failure on the nerves.
- Buildup of waste products: Toxins that the failing kidneys cannot remove are thought to damage the nerves.
- Chronic kidney disease: The neuropathy is closely tied to how severe and longstanding the kidney failure is.
Other factors common in people with kidney disease, such as diabetes, vitamin deficiencies, and certain medications, can contribute to or worsen nerve damage and are considered during evaluation.
Risk Factors
- Advanced or longstanding chronic kidney disease
- Inadequate dialysis or delayed start of treatment
- Coexisting diabetes, a major cause of neuropathy on its own
- Nutritional deficiencies common in kidney disease
- Longer duration of severe kidney failure
Diagnosis
Diagnosis links the neuropathy to kidney failure while ruling out other causes.
- Nerve conduction studies and EMG: Document the pattern and severity of nerve damage.
- Blood tests: Assess kidney function and look for other contributors such as diabetes and vitamin deficiencies.
- Clinical examination: Tests sensation, strength, and reflexes in the limbs.
- Review of medications: Some drugs used in kidney disease can affect the nerves.
Treatment
Treatment centers on improving kidney function and clearance of toxins, along with relieving symptoms.
- Adequate dialysis: Effective, sufficient dialysis can stabilize and sometimes improve the neuropathy.
- Kidney transplantation: A successful transplant often leads to meaningful improvement in nerve symptoms over time.
- Symptom relief: Medications for nerve pain and restless legs, used carefully with attention to kidney dosing.
- Addressing contributors: Controlling diabetes, correcting deficiencies, and reviewing medications.
How much the neuropathy improves depends on its severity and how well the underlying kidney failure is managed.
Prevention
- Manage chronic kidney disease early to slow its progression
- Follow your prescribed dialysis schedule and aim for adequate treatment
- Keep diabetes and blood pressure well controlled
- Maintain good nutrition and address any vitamin deficiencies
- Review medications with your care team to avoid those that harm nerves
When to See a Doctor
See your kidney care team if you develop numbness, tingling, burning, restless legs, or weakness, especially if you have chronic kidney disease. Seek prompt evaluation for:
- Worsening weakness or trouble walking
- New or rapidly progressing numbness
- Foot wounds or sores, which may go unnoticed when sensation is reduced
- Symptoms suggesting your kidney disease is worsening
Frequently Asked Questions
What causes uremic neuropathy?
It is caused by advanced kidney failure. When the kidneys cannot filter the blood, waste products and toxins build up and are thought to damage the peripheral nerves. The neuropathy is closely tied to how severe and longstanding the kidney failure is.
Can dialysis help uremic neuropathy?
Yes. Adequate, effective dialysis can stabilize the neuropathy and sometimes improve symptoms by clearing more of the toxins that damage nerves. Insufficient dialysis is associated with worse nerve symptoms.
Does a kidney transplant improve nerve symptoms?
Often it does. A successful kidney transplant restores much better filtering of the blood, and many people see their nerve symptoms improve over the following months, though severe long-standing damage may not fully reverse.
What are the first symptoms?
Most people first notice numbness, tingling, or burning in the feet and lower legs, along with restless legs and muscle cramps. Weakness usually develops later than these sensory symptoms.
How is uremic neuropathy different from diabetic neuropathy?
Both cause similar symptoms and often occur together, since many people with kidney failure also have diabetes. Uremic neuropathy is driven by the buildup of toxins in kidney failure, while diabetic neuropathy is driven by high blood sugar. Doctors consider both when evaluating nerve symptoms.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Chronic Kidney Disease.
- National Kidney Foundation. Nerve problems and kidney disease.
- MedlinePlus, U.S. National Library of Medicine. Peripheral nerve disorders.
- National Library of Medicine. StatPearls: Uremic Neuropathy.