HDCN Article Review/Hyperlink

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)