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"H" reflex as a measure of subclinical uremic polyneuropathy in children with chronic renal failure
L Mendoza-Guevara1, A Cervantes, A Aguilar-Kitsu
1Department of Nephrology, Hospital de Pediatria, Mexico City, Mexico.
Insights
Uremic polyneuropathy (UPNP) affects over half of pediatric patients with chronic renal failure (CRF). The "H" reflex maneuver is a valuable screening tool for detecting asymptomatic UPNP in these children.
Area of Science:
- Pediatric Nephrology
- Neurology
- Clinical Diagnostics
Background:
- Uremic polyneuropathy (UPNP) is a known complication of chronic renal failure (CRF) in adults, but its prevalence in children is not well-established.
- Early detection of UPNP in pediatric CRF patients is crucial for timely intervention and management.
Purpose of the Study:
- To validate the utility of the "H" reflex maneuver for diagnosing UPNP in pediatric patients undergoing dialysis for CRF.
- To assess the prevalence of UPNP in this pediatric population.
Main Methods:
- A cohort of 37 pediatric CRF patients on dialysis was compared to age- and sex-matched healthy controls.
- Neurological examinations, nerve conduction velocities, and bilateral "H" reflex measurements were performed.
- UPNP was diagnosed based on alterations in nerve latency and/or conduction velocities.
Main Results:
- Nearly 60% (59.4%) of pediatric CRF patients on dialysis exhibited UPNP, often asymptomatically.
- The "H" reflex demonstrated a specificity of 87% at 28 msec, increasing to 95% at 30 msec, indicating its diagnostic potential.
- No significant differences were found in CRF diagnosis, dialysis duration, or control between UPNP and non-UPNP patient groups.
Conclusions:
- Uremic polyneuropathy is a common, often asymptomatic, complication in pediatric patients with chronic renal failure.
- "H" reflex testing serves as an effective screening method for identifying pediatric CRF patients who require further evaluation for UPNP.
Abstract:
Uremic polyneuropathy (UPNP) is a serious complication of chronic renal failure (CRF) in adults; however, its prevalence is unknown in the pediatric population. An easy-to-perform maneuver for its detection in children is the evaluation of "H" reflex. The objective of this study was to validate the usefulness of the "H" reflex maneuver for the diagnosis of UPNP in pediatric dialysis patients for CRF. Thirty-seven CRF patients were paired with healthy controls by age and sex. The patients were being treated with dialysis or one of its variants. Information was obtained regarding diagnosis, duration, and control of dialysis. Neurological examination was performed, conduction velocities in sensory and motor nerves were measured, and "H" reflex elicited bilaterally. Peripheral polyneuropathy was determined by the presence of at least two nerves with alterations in latency and/or conduction velocities. It was found that 59.4% (22/37) of the children with CRF treated with dialysis developed UPNP, 17 with ambulatory peritoneal dialysis, and 5 with hemodialysis. There was no difference in diagnosis, duration of dialysis, or control of the same in these patients from other CRF patients who did not have UPNP. All patients were clinically asymptomatic. "H" reflex showed a sensibility of 44%, a specificity of 87%, a predictive value positive of 66%, and a predictive value negative of 76%, when measured to 28 msec. With a 30 msec duration specificity rises to 95%. UPNP presents asymptomatically in pediatric patients. "H" reflex is an adequate screening test for the selection of pediatric patients to be tested further.