Progressive, predominantly motor, uraemic neuropathy

A severe rapidly progressive neuropathy is described in 4 young male adults with end-stage renal failure, 3 of whom had accelerated hypertension. The onset of symptoms developed after regular haemodialysis had been started and in all 4 patients was closely associated with a septicaemic illness. In 2 patients, renal transplantation led to considerable clinical improvement, and in a third patient charcoal haemoperfusion halted further clinical progression of the neuropathy. This improvement was not reflected by the nerve conduction studies which remained grossly impaired. A possible ischaemic aetiology related to accelerated hypertension and septicaemia is suggested for this unusual variant of uraemic neuropathy.