Thermal sensitivity in uremic neuropathy

Clinical neurological examination, nerve conduction velocity measurements, and quantitative tests of thermal and vibratory sensitivity were performed in 64 non-diabetic uremic patients, who were all treated with chronic maintenance dialysis. Clinical or neurographic signs of neuropathy were found in 83% of the patients. The most common abnormalities were reduced nerve conduction velocity, increased vibratory perception threshold, loss of tendon reflexes, and impaired temperature sensibility. Hypesthesia to pinprick or touch, or paresis were rarely found and none of them was ever the first sign of neuropathy. Thermal sensation was abnormal in 30% of the patients, which is a much higher prevalence than that which has previously been reported. There were no significant correlations between measures of thermal sensation and measures of large fibre dysfunction. Impaired thermal discrimination was the first sign of neuropathy in 15% of the patients. This indicates that a small fibre uremic neuropathy may exist as a separate entity.