Rapid Improvement in Nerve Conduction Velocity Following Renal Transplantation Shin J. O h , MD, Rex S . Clements, Jr, MD, Young W. Lee, MD, and Arnold G. Diethelm, MD
I n 12 patients with chronic renal failure who received kidney transplants from either cadavers (6) or related living donors (6),rapid improvement i n median sensory and motor nerve conduction velocities (NCVs) was observed within a few days after transplantation. T h e postoperative improvement in median sensory N C V was found to bear a statistically significant negative correlation with creatinine and myo-inositol concentrations. We suggest that metabolic phenomena are responsible for the rapid improvement in median sensory N C V following renal transplantation. T h e close relationship between myo-inositol and t h e median sensory N C V following transplantation suggests that elevated plasma myo-inositol concentrations may be related to nerve conduction abnormalities in uremic polyneuropathy. Oh SJ, Clements RS Jr, Lee YW, et al: Rapid improvement in nerve conduction velocity following renal transplantation. Ann Neurol4:369-373, 1978
I n recent years, peripheral neuropathy has come to be recognized as a common complication of chronic renal failure. Successful renal transplantation has consistently resulted in improvement in clinical uremic ncuropathy and nerve conduction velocities (NCVs) over a period of several months [3,9, 10,12, 151. We report rapid improvement in NCVs o n posttransplantation days 2 and 5 , reflecting the acute metabolic alterations that follow renal transplantation.
Patients and Methods The study group consisted of 12 consecutive patients who underwent renal transplantation at the Birmingham Veterans Administration Hospital. All provided fully informed written consent prior to their participation in this study. The clinical characteristics of these patients are outlined in Table 1. The group contained 9 men and 3 women with an average age of 31.0 f 3.6 years (mean rt SEM). All wete maintained on a chronic hemodialysis program prior to transplantation and received a standard perioperative immunosuppressive regimen of antilymphocyte globulin, methylprednisolone, and azathioprine. Six patients received kidneys from related living donors and 6 patients received cadaver kidneys. In none of the patients was obvious clinical neuropathy present. Subclinical neuropathy (nocturnal cramps, decreased peripheral vibratory and pain sensations, and decreased Achilles reflexes) was observed in 8 patients.
Nerve conduction velocity determinations were performed preoperatively on an afternoon prior to hemodialysis and on the afternoons of the first, second, fifth, twelfth, and nineteenth postoperative days, using a DISA 14A11 electromyograph. To assure reproducibility, median motor (over the forearm segment), median sensory (over the finger-wrist segment), peroneal motor (over the ankle-knee segment), and sural sensory (over the lower calf segment) NCV determinations were always performed on the same extremity in the individual subjects. Each determination was repeated ten times, and the mean values were corrected to a skin temperature of 35°C according to the formula of DeJesus et al [8]. When an NCV was less than 2 standard deviations from the temperature-adjusted mean value for the normal controls, it was considered subnormal. The temperatureadjusted NCV in the normal controls was 63.62 rt 2.41 mlsec (mean SD) in median motor, 47.81 f 3.49 in median sensory, 55.70 f 3.98 in peroneal motor, and 44.82 f 2.74 in sural sensory nerves. Serum creatinine and urea nitrogen determinations were performed by autoanalyzer techniques [ 171. The myoinositol concentration was determined by gas-liquid chromatography as described by Clements and Starnes [6].
*
Results Following renal transplantation, increases in median motor, median sensory, peroneal motor, and sural sensory NCVs were observed in all but 2 patients, ~
From the Departments of Neurology, Medicine, and Surgery, University of Alabama School of Medicine, and the Metabolic and Renal Transplantation Research Laboratories, Veterans Administration Hospital, Birmingham, AL.
Accepted for publication Apr 24, 1978. Address reprint requests to Dr Oh, Department of Neurology, University of A,abma Center, Birmingham, 35233.
0364-5134/78/0004-0412$01.25 @ 1978 by Shin J. Oh 369
Table I. Clinical Characteristirs of 12 Kidney Transplant Recipients ~~
Preoperative Laboratory Values Patient No., Age (yr), and Sex 1. 19, M
2. 8 , M 3. 48, M 4 . 25, M 5 . 31, M 6. 30, F 7 . 16, F 8 . 34, M 9. 44, M 10. 4 9 , M 11. 3 3 , M 12. 35, F Normal
Serum Urea Nitrogen (mgldl)
Serum Creatinine (mddl)
Plasma Myo-inositol
Diagnosis
Donor
Chronic pyelonephritis Chronic pyelonephritis Polycystic disease Chronic glomerulonephritis Chronic glomerulonephritis Chronic pyelonephritis and arterionephrosclerosis Medullary cystic disease Goodpasture's syndrome Chronic glomerulonephritis Polycystic disease Arterionephrosclerosis Arterionephrosclerosis
Mother Cadaver Cadaver Mother Cadaver Cadaver
69 20 94 70 78 97
15.0 2.8 12.5 10.8 13.7 17. I
364.2 88.3 243.3 101.1 174.7 324.9
Mother Brother Father Cadaver Brother Cadaver
99 128 74 116
9.7 22.8 12.6 13.1 22.5 6.4
I n 12 patients with chronic renal failure who received kidney transplants from either cadavers (6) or related living donors (6),rapid improvement i n median sensory and motor nerve conduction velocities (NCVs) was observed within a few days after transplantation. T h e postoperative improvement in median sensory N C V was found to bear a statistically significant negative correlation with creatinine and myo-inositol concentrations. We suggest that metabolic phenomena are responsible for the rapid improvement in median sensory N C V following renal transplantation. T h e close relationship between myo-inositol and t h e median sensory N C V following transplantation suggests that elevated plasma myo-inositol concentrations may be related to nerve conduction abnormalities in uremic polyneuropathy. Oh SJ, Clements RS Jr, Lee YW, et al: Rapid improvement in nerve conduction velocity following renal transplantation. Ann Neurol4:369-373, 1978
I n recent years, peripheral neuropathy has come to be recognized as a common complication of chronic renal failure. Successful renal transplantation has consistently resulted in improvement in clinical uremic ncuropathy and nerve conduction velocities (NCVs) over a period of several months [3,9, 10,12, 151. We report rapid improvement in NCVs o n posttransplantation days 2 and 5 , reflecting the acute metabolic alterations that follow renal transplantation.
Patients and Methods The study group consisted of 12 consecutive patients who underwent renal transplantation at the Birmingham Veterans Administration Hospital. All provided fully informed written consent prior to their participation in this study. The clinical characteristics of these patients are outlined in Table 1. The group contained 9 men and 3 women with an average age of 31.0 f 3.6 years (mean rt SEM). All wete maintained on a chronic hemodialysis program prior to transplantation and received a standard perioperative immunosuppressive regimen of antilymphocyte globulin, methylprednisolone, and azathioprine. Six patients received kidneys from related living donors and 6 patients received cadaver kidneys. In none of the patients was obvious clinical neuropathy present. Subclinical neuropathy (nocturnal cramps, decreased peripheral vibratory and pain sensations, and decreased Achilles reflexes) was observed in 8 patients.
Nerve conduction velocity determinations were performed preoperatively on an afternoon prior to hemodialysis and on the afternoons of the first, second, fifth, twelfth, and nineteenth postoperative days, using a DISA 14A11 electromyograph. To assure reproducibility, median motor (over the forearm segment), median sensory (over the finger-wrist segment), peroneal motor (over the ankle-knee segment), and sural sensory (over the lower calf segment) NCV determinations were always performed on the same extremity in the individual subjects. Each determination was repeated ten times, and the mean values were corrected to a skin temperature of 35°C according to the formula of DeJesus et al [8]. When an NCV was less than 2 standard deviations from the temperature-adjusted mean value for the normal controls, it was considered subnormal. The temperatureadjusted NCV in the normal controls was 63.62 rt 2.41 mlsec (mean SD) in median motor, 47.81 f 3.49 in median sensory, 55.70 f 3.98 in peroneal motor, and 44.82 f 2.74 in sural sensory nerves. Serum creatinine and urea nitrogen determinations were performed by autoanalyzer techniques [ 171. The myoinositol concentration was determined by gas-liquid chromatography as described by Clements and Starnes [6].
*
Results Following renal transplantation, increases in median motor, median sensory, peroneal motor, and sural sensory NCVs were observed in all but 2 patients, ~
From the Departments of Neurology, Medicine, and Surgery, University of Alabama School of Medicine, and the Metabolic and Renal Transplantation Research Laboratories, Veterans Administration Hospital, Birmingham, AL.
Accepted for publication Apr 24, 1978. Address reprint requests to Dr Oh, Department of Neurology, University of A,abma Center, Birmingham, 35233.
0364-5134/78/0004-0412$01.25 @ 1978 by Shin J. Oh 369
Table I. Clinical Characteristirs of 12 Kidney Transplant Recipients ~~
Preoperative Laboratory Values Patient No., Age (yr), and Sex 1. 19, M
2. 8 , M 3. 48, M 4 . 25, M 5 . 31, M 6. 30, F 7 . 16, F 8 . 34, M 9. 44, M 10. 4 9 , M 11. 3 3 , M 12. 35, F Normal
Serum Urea Nitrogen (mgldl)
Serum Creatinine (mddl)
Plasma Myo-inositol
Diagnosis
Donor
Chronic pyelonephritis Chronic pyelonephritis Polycystic disease Chronic glomerulonephritis Chronic glomerulonephritis Chronic pyelonephritis and arterionephrosclerosis Medullary cystic disease Goodpasture's syndrome Chronic glomerulonephritis Polycystic disease Arterionephrosclerosis Arterionephrosclerosis
Mother Cadaver Cadaver Mother Cadaver Cadaver
69 20 94 70 78 97
15.0 2.8 12.5 10.8 13.7 17. I
364.2 88.3 243.3 101.1 174.7 324.9
Mother Brother Father Cadaver Brother Cadaver
99 128 74 116
9.7 22.8 12.6 13.1 22.5 6.4
