Pena JM, Fernandez E, Borras M, Montoliu J
A dialysis patient with unexplained peripheral neuropathy
Nephrol Dial Transplant
(Sep) 11:1867-1869 1996

This is a case report of a CAPD patient with ESRD secondary to bilateral
staghorn calculi and
chronic interstitial nephropathy who developed increasing paresthesias and
weakness in both legs two
years after beginning dialyis. Underdialysis was ruled out because weekly
Kt/V was 2.0 and
creatinine clearance was 80 liters/week. She also had pretibial skin ulcers.
No purpuric lesions
were seen.
To make a long story short, despite normal transaminase levels and LDH,
cryoglobulins of the mixed
polyclonal (type III) variety were found with hepatitis C RNA in the
cryoprecipitate. After
treatment with plasmapheresis and alfa-interferon, cryoglobulins resolved,
the skin ulcers healed,
and the neuropathy improved.
Comment: HCV is an uncommon cause of neuropathy in ESRD patients,
although a substantial
number of them do have HCV infection. Nevertheless, one should consider HCV
and cryoglobulinemia in
ESRD patients who present with peripheral neuropathy. In this particular
case, however, the skin
ulcers were an important tip-off. Otherwise, diabetes, ethanol abuse,
amyloidosis, malnutrition,
polyarteritis, lupus, multiple myeloma, and thiamine deficiency all figure in
this differential
diagnosis.
(John T. Daugirdas, M.D., University of Illinois at Chicago)