Polineuropatia urêmica: estudo clínico-eletroneurográfico de 33 casos

Werneck, Lineu Cesar; Mulinari, Adyr Soares; Laffite, Augusto; Kesikowski, Luiz Bore

doi:10.1590/S0004-282X1979000400002

Resumos

Neste estudo foram avaliados 33 pacientes com polineuropatia e insuficiência renal crônica. A idade dos pacientes variou entre 18 e 58 anos, sendo 26 do sexo masculino e 9 do feminino. Todos os pacientes apresentavam níveis de uréia acima de 100 mg/dl e creatinina acima de 5,0 mg/dl. 10 pacientes foram mantidos com hemodiálise crônica, 13 com diálise peritoneal semanal e 10 com tratamento clinico conservador (controles). Foram realizadas medidas da condução nervosa motora nos nervos mediano, ulnar e peroneiro em todos os pacientes, concomitante com a avaliação clínica. Os pacientes foram divididos em grupos, conforme a intensidade da neuropatia presente. Os sintomas mais freqüentes foram diminuição do senso de vibração, câimbras e hipoestesia distai para tacto. O nervo mais afetado foi o peroneiro (97,82%), seguido do mediano e ulnar. O procedimento dialítico alterou pouco a condução nervosa, quando as aferições eram realizadas antes e depois da mesma diálise. Não houve nenhuma diferença estatisticamente significante entre os grupos de hemodiálise e diálise peritoneal na avaliação clinica ou eletroneurográfica. Em 7 pacientes seguidos por vários anos, a condução nervosa manteve-se estável em dois, aumentou em dois e baixou em três, acompanhando a evolução dos sintomas. Nos três que pioraram, houve desenvolvimento paralelo de hiper-paratireoidismo secundário. Os autores concluem que o nervo peroneiro é o que melhores condições fornece para o seguimento e avaliação clinica dos pacientes com uremia, apresentando tendência para diminuir a condução nervosa, quando existe piora da sintomatologia, sem relação com o tipo de diálise empregado.

The clinic-neurographic study of 33 patients with renal failure and polyneuropathy is reported. The patient's age ranged between 18 and 58 years-old; 24 were males and 9 female. All the patients had blood urea levels above 100 mg/dl. and creatinine levels above 5,0 mg/dl. Ten patients were maintained by repetitive haemodialysis twice a week; thirteen with weekly peritoneal dialysis; ten with conservative methods (controls). All the patients had motor nerve conduction velocities (VCNM) measured in the median, ulnar and peroneal nerves, at same time of the clinical avaliation. According to the intensity of the neuropathy the patients were divided in four groups. Decreased vibratory sense, cramps and distal hypoestesia for fine touch were the most frequent symptoms disclosed. The peroneal VCNM was decreased in 97,82% of the cases, followed by the median (84,78%) and ulnar (82.60%). The autrors did not found a significant alteration in the VCNM before and after dialysis, and between the kind of dialysis used (peritoneal and haemo-dialysis). In 7 patients followed for years, the VCNM was stable in 2, increased in 2 and decreased in 3, when they become stable, improved or worsened theirs symptoms. Secondary hyperparathyroidism developes in the 3 patients who worsened the symptoms and decreases theirs VCNM. The authors found the peroneal VCNM studies very usefull and was the one who gave more data regarding the evaluation and follow-up of the patients with uraemia, showing a tendency of the VCNM decreased with worsening of the clinical symptoms, without relationship with the kind of dialysis procedure (peritoneal or haemodialysis).

Polineuropatia uremica: estudo clínico-eletroneurografico de 33 casos

Uraemic neuropathy: a clinical-etectroneurographic study in 33 patients

Lineu Cesar Werneck^I; Adyr Soares Mulinari^II;Augusto Laffite^III; Luiz Bore Kesikowski^IV

^IProfessor Assistente de Neurologia. Departamento de Clínica Médica da Universidade Federal do Paraná

^IIProfessor Titular de Nefrologia. Departamento de Clínica Médica da Universidade Federal do Paraná

^IIIProfessor Assistente de Nefrologia. Departamento de Clínica Médica da Universidade Federal do Paraná

^IVProfessor Assistente de Estatística. Departamento de Clínica Médica da Universidade Federal do Paraná

RESUMO

Neste estudo foram avaliados 33 pacientes com polineuropatia e insuficiência renal crônica. A idade dos pacientes variou entre 18 e 58 anos, sendo 26 do sexo masculino e 9 do feminino. Todos os pacientes apresentavam níveis de uréia acima de 100 mg/dl e creatinina acima de 5,0 mg/dl. 10 pacientes foram mantidos com hemodiálise crônica, 13 com diálise peritoneal semanal e 10 com tratamento clinico conservador (controles).

Foram realizadas medidas da condução nervosa motora nos nervos mediano, ulnar e peroneiro em todos os pacientes, concomitante com a avaliação clínica. Os pacientes foram divididos em grupos, conforme a intensidade da neuropatia presente.

Os sintomas mais freqüentes foram diminuição do senso de vibração, câimbras e hipoestesia distai para tacto. O nervo mais afetado foi o peroneiro (97,82%), seguido do mediano e ulnar. O procedimento dialítico alterou pouco a condução nervosa, quando as aferições eram realizadas antes e depois da mesma diálise. Não houve nenhuma diferença estatisticamente significante entre os grupos de hemodiálise e diálise peritoneal na avaliação clinica ou eletroneurográfica. Em 7 pacientes seguidos por vários anos, a condução nervosa manteve-se estável em dois, aumentou em dois e baixou em três, acompanhando a evolução dos sintomas. Nos três que pioraram, houve desenvolvimento paralelo de hiper-paratireoidismo secundário.

Os autores concluem que o nervo peroneiro é o que melhores condições fornece para o seguimento e avaliação clinica dos pacientes com uremia, apresentando tendência para diminuir a condução nervosa, quando existe piora da sintomatologia, sem relação com o tipo de diálise empregado.

SUMMARY

The clinic-neurographic study of 33 patients with renal failure and polyneuropathy is reported. The patient's age ranged between 18 and 58 years-old; 24 were males and 9 female. All the patients had blood urea levels above 100 mg/dl. and creatinine levels above 5,0 mg/dl. Ten patients were maintained by repetitive haemodialysis twice a week; thirteen with weekly peritoneal dialysis; ten with conservative methods (controls).

All the patients had motor nerve conduction velocities (VCNM) measured in the median, ulnar and peroneal nerves, at same time of the clinical avaliation. According to the intensity of the neuropathy the patients were divided in four groups.

Decreased vibratory sense, cramps and distal hypoestesia for fine touch were the most frequent symptoms disclosed. The peroneal VCNM was decreased in 97,82% of the cases, followed by the median (84,78%) and ulnar (82.60%).

The autrors did not found a significant alteration in the VCNM before and after dialysis, and between the kind of dialysis used (peritoneal and haemo-dialysis). In 7 patients followed for years, the VCNM was stable in 2, increased in 2 and decreased in 3, when they become stable, improved or worsened theirs symptoms. Secondary hyperparathyroidism developes in the 3 patients who worsened the symptoms and decreases theirs VCNM.

The authors found the peroneal VCNM studies very usefull and was the one who gave more data regarding the evaluation and follow-up of the patients with uraemia, showing a tendency of the VCNM decreased with worsening of the clinical symptoms, without relationship with the kind of dialysis procedure (peritoneal or haemodialysis).

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Full text available only in PDF format.

Trabalho realizado nas Disciplinas de Neurologia e Nefrologia do Departamento de Clínica Médica da Universidade Federal do Paraná.

Disciplinas de Neurologia - hospital de Clínicas da Universidade Federal do Paraná - Rua General Carneiro 180 - 80000 Curitiba, PR - Brasil.

1. APPENZELLER, O.; KORNFELD, M. & MacGEE, J. - Neuropathy in chronic renal renal disease: a microscopic, ultrastructural and biochemical study of sural nerve biopsies. Arch. Neurol. (Chicago) 24:449, 1971.
2. ASBURY, A. K.; VICTOR, M. & ADAMS, R. D. - Uremic polyneuropathy. Arch. Neurol. (Chicago) 8:413, 1963.
3. BAKΧE, L. - Uraemic polyneuropathy. Acta Neurol. Scand. 46:205, 1970. (Supl. 43).
4. BEVEN, E. G, & HERTZER, N. R. - Construction of arteriovenous fistulas for hemodialysis. Surg. Clin. N. Amer. 55:1125, 1975.
5. BLAGG, C. R.; KEMBLE, F. & TAVERNER, D. - Nerve conduction velocity in relationship to the severity of renal disease. Nephron 5:290, 1968.
6. BOEN, S. T. - Kinetics of peritoneal dialysis. Medicine (Baltimore) 4:243, 1961.
7. BOLTON, C. F.; LINDSAY, R. M. & LINTON, A. L. - Uremic neuropathy in patients on different hemodialysis schedules. Neurology (Minneapolis) 27:396, 1977.
8. BRESCIA, M. J.; CIMINO, J. E.; APPEL, K. & HURWICK, B. J. - Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. New England J. Med. 275:1089, 1966.
9. BUCHTHAL, F. - Electrophysiological abnormalities in metabolic myopathies and neuropathies. Acta Neurol. Scand. 46:129, 1970 (Supl. 43).
10. BUTT, K. M.; KOUNTZ, S. L. & FRIEDMAN, E. A. - Angioaccess for hemodialysis: which, when, why. Clin. Nephrol. 3:207, 1975.
11. CHARCOT, J. M. - Lecons sur les maladies du fois et des voies biliaires et des reins. Progrfcs Medical, Paris, 1877.
12. COOMES, E. N.; BERLYNE, G. M. & SHAW, A. B. - Incidence of neuropathy in non-dialysed chronic renal failure patients. In Proceedings of the European Dialysis and Transplant Association. Excerpta Medica, International Congress Series 2:138, 1965.
13. DAVISON, P. F. - Axoplasmic transport: physical and chemical aspects. In The Neurociences - 2nd. Study Program, Editado por Schmitt, F.O., Rockefeller Univ. Press, New York, 1970.
14. DAYAN, A. D.; GARDNER-THORPE, C.; DOWN, P. F & GLEADE, R. I. - Peripheral neuropathy in uremia. Neurology (Minneapolis) 20:649, 1970.
15. DYCK, F. J.; JOHNSON, W. J.; LAMBERT, E. H. & O'BRIEN, P. C. - Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin. Proc. 46:400, 1971.
16. FUNCK-BRENTANO, J. L.; CHAUMONT, P. & VANTELON, J. - Polynévrite au cours de l'uremie chronique: evolution aprés transplantation renal (10 observations personneles). Nephron 5:31, 1968.
17. GASSEL, M. M. - Sources of error in motor nerve conduction studies. Neurology (Minneapolis) 14:825, 1964.
18. GOODGOLG, J. & EBERTEIN, A. - Electrodiagnosis of Neuromuscular Disease. The Williams Wilkins Co., Baltimore, 1972.
19. HAUSMANOWA-PETRUSEWICZ, 1.; EMERYK, B. & LAO, H. - Analyse electromyographique de Thyperkeliemie dans l'insuffisance rénale. J. Electroenceph. Clin. Neurophysiol. Supl. 22:154, 1962.
20. JEBSEN, R, H. & TENCKHOFF, H. - Comparison of motor and sensory nerve conduction velocity in early uremic polyneuropathy. Arch. Phys. Med. & Rehab. 50:124, 1969.
21. JEBSEN, R. H.; TENCKHOFF, H. & HONET, J. C. - Natural history of uremic polyneuropathy and effects of dialysis. New Engl. J. Med. 277:327, 1967.
22. JENNEKENS, F. G. I.; MESS, E. J. D. & SPIJK, D. M. - Clinical aspects of uraemic polyneuropathy. Nephron 8:414, 1971.
23. KJELISTRAND, C. M.; PETERSEN, R. J.; EVANS, R. L.; SHIDMAN, J. R., von HARTITZSH, B. & BULSEMEYER, T. J. - A test of the "midler molecule hypothesis: Neuropathy in nephrectomized patients. Proc. Amer. Soc. Artif. Intern. Organs" XIX Anual Meeting, April 1973, Boston (Resumo).
24. KOMINAMI, N.; TYLER, R.; HAMPERS, C. L. & MERRIL, J. P. - Variation in motor nerve conduction velocity in normal and uremic patients. Arch. Intern. Med. 128:235, 1971.
25. KONOTEY-AHULU, F. I. D.; BAILLOD, R.; COMTY, C. M.; HERON, J. R.; SHALDON, S. & THOMAS, P. K. - Effect of periodic dialysis on the peripheral neuropathy of end-stage renal failure. Brit. Med. J. 2:1212, 1965.
26. LYNCH, P. G.; YUILL, G. W. & NICHOLSON, J. A. H. - Acute polyneuropathy complicating chronic renal failure. Nephron 8:278, 1971.
27. MAN, N. K.; TERLAIN, B.; PARIS, J.; WERNER, G.; SAUSSE, A. & FUNCK-BRENTANO, J. L. - An approach for "middle molecules" identification in artificial kidney dialysate: application to neuropathy prevention. Proc. Amer. Soc. Artif. Intern. Organs, XIX Annual Meeting, April 1973, Boston (Resumo).
28. McQUILLEN, M. P.; PROCOPIS, P. G. & LUKE, R. G. - Nerve excitability in chronic renal disease. Proc. Amer. Soc. Artif. Intern. Organs, XIX Annual Meeting, April 1973, Boston (Resumo).
29. MILLER, D. W.; NELSON, J. A. & BENDER, L. F. - Measurement of latency in facial nerve in normal and uremic persons. Arch. Phys. Med. & Rehab. 51:413, 1970.
30. NIELSEN, V. K. - Recovery from peripheral neuropathy after renal transplantation. Acta Neurol. Scand. 46:207, 1970, Supl. 43.
31. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: clinical symptoms and signs. Acta Med. Scand. 190:105, 1971.
32. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: inter-correlacion of clinical symptoms and signs and clinical grading of neuropathy. Acta Med. Scand. 190:113, 1971.
33. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: an analysis of the vitJratory perception thereshold. Acta. Med. Scand. 191:287, 1972.
34. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: sensory and motor conduction velocity. Acta Med. Scand. 194:445, 1973.
35. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: the relationship between sensory and motor nerve conduction and kidney function, azotemia, age, sex and clinical neuropathy. Acta Med. Scand. 194:455, 1973.
36. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: longitudinal course during terminal renal failure and regular hemodialysis. Acta Med. Scand. 195:155, 1974.
37. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: recovery after renal transplantation-clinical aspects. Acta Med. Scand. 195:163, 1974.
38. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: recovery after renal transplantation: electrophysiological aspects. Acta Med. Scand. 195:171, 1974.
39. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: decremental nerve conduction in uremia? Acta Med. Scand. 196:83, 1974.
40. OH, J. S.; CLEMENTS, R. S.; LEE, T. M. & DIETHELM, A. G. - Rapid improvement in nerve conduction velocity following renal transplantation. Ann. Neurology 4:369, 1978.
41. OSLER, W. - The Principles and Practices of Medicine. Appleton, New York, 1892.
42. PAKXENBERG, H.; CHRISTOFFERSEN, P.; NIELSN, B. & LARSEN, N. A. - Polyneuropathy in patients with uraemia treated with dialysis. Acta Neurol Scand. 46:206, 1970 (Supl. 43).
43. POPOVITZER, M. M.; ROSEBAUM, B. J.; GORDON, A. & MAXWELL, M. - Relief of uremic polyneyropathy after bilateral nephrectomy, New Engl. J. Med. 281:949, 1969.
44. PRESWICK, G. & JEREMY, D. - Subclinical polyneuropathy in renal insufficiency. Lancet 2:731, 1964.
45. QUINTON, W. E.; DILLARD, D. H.; COLLE, J. J. & SCRIBNER, B. H. - Eight months experiences with silastic-teflon bypass cannulas. Trans. Amer. Soc. Artif. Intern. Organs 7:136, 1961.
46. QUINTON, W.; DILLARD, D. H. & SCHRIBNER, B. H. - Cannulation of blood vessels for prolonged hemodialysis. Trans. Amer. Soc. Artif. Intern. Organs 6:104, 1960.
47. RASKIN, N. H. & FISHMAN, R. A. - Neurologic disorders in renal failure. Ndw Engl. J. Med. 294:204, 1976.
48. RECORD, N. B.; PRICHARD, J. W.; GALLAGHER, B. B. & SELIGSON, D. - Phenolic acids in experimental uremia: a potencial role of phenolic acids in the neurological manifestation of uremia. Arch. Neurol. (Chicago) 21:387, 1969.
49. BYMPSON, J. A. - Fact and fallacy in measurement of conduction velocity in motor nerves. J. Neurol. Neurosurg. Psychiat. 24:381, 1964.
50. SMORTO, M. P. & B AS MA JI AN, J. V. - Clinical Electroneurography. The Williams & Wilkins Co., Baltimore,
51. SOREL, M. R. & CAFFORT, R. Les polynévrites urémiques. Press Med. 4:80, 1936.
52. SORIANO, G. & EISINGER, R. P. - Abnormal response to the Valsalva maneuver in patients on chronic hemodialysis. Nephron 9:251, 1972.
53. STRIKER, G. E. & TENCKHOFF, H. - A transcutaneous prosthesis for prolonged access to the peritoneal cavity. Surgery 69:70, 1971.
54. TAYLOR, N.; JEBSEN, R. H. & TENCKHOFF, H. A. - Facial nerve conduction latency in chronic renal insufficiency. Arch. Phys. Med. & Rehab. 51:259, 1970.
55. TENCKHOFF, H. - Chronic Peritoneal Dialysis. University of Washington Press, Seatle, 1974.
56. TENCKHOFF, H.; BOEN, P. S.; JEBSEN, R. H. & SPIEBLER, J. H. - Polyneuropathy in chronic renal insufficiency. J.A.M.A. 192:91, 1965.
57. TENCKHOFF, H. & SCHECHTER, H. - A bacteriological safe peritoneal access. Trans. Amer. Soc. Artif. Inter. Organs 14:181, 1968.
58. VERSACI, A. A.; OLSEN, K. J.; McMAIN, P. B.; NAKAMOTO, S. & KOLFF, W. J. - Uremic polyneuropathy and motor nerve conduction velocities. Trans. Amer. Soc. Artif. Intern. Organs 10:328, 1964.

Datas de Publicação

Publicação nesta coleção
22 Ago 2012
Data do Fascículo
Dez 1979

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. APPENZELLER, O.; KORNFELD, M. & MacGEE, J. - Neuropathy in chronic renal renal disease: a microscopic, ultrastructural and biochemical study of sural nerve biopsies. Arch. Neurol. (Chicago) 24:449, 1971.

[2] 2. ASBURY, A. K.; VICTOR, M. & ADAMS, R. D. - Uremic polyneuropathy. Arch. Neurol. (Chicago) 8:413, 1963.

[3] 3. BAKΧE, L. - Uraemic polyneuropathy. Acta Neurol. Scand. 46:205, 1970. (Supl. 43).

[4] 4. BEVEN, E. G, & HERTZER, N. R. - Construction of arteriovenous fistulas for hemodialysis. Surg. Clin. N. Amer. 55:1125, 1975.

[5] 5. BLAGG, C. R.; KEMBLE, F. & TAVERNER, D. - Nerve conduction velocity in relationship to the severity of renal disease. Nephron 5:290, 1968.

[6] 6. BOEN, S. T. - Kinetics of peritoneal dialysis. Medicine (Baltimore) 4:243, 1961.

[7] 7. BOLTON, C. F.; LINDSAY, R. M. & LINTON, A. L. - Uremic neuropathy in patients on different hemodialysis schedules. Neurology (Minneapolis) 27:396, 1977.

[8] 8. BRESCIA, M. J.; CIMINO, J. E.; APPEL, K. & HURWICK, B. J. - Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. New England J. Med. 275:1089, 1966.

[9] 9. BUCHTHAL, F. - Electrophysiological abnormalities in metabolic myopathies and neuropathies. Acta Neurol. Scand. 46:129, 1970 (Supl. 43).

[10] 10. BUTT, K. M.; KOUNTZ, S. L. & FRIEDMAN, E. A. - Angioaccess for hemodialysis: which, when, why. Clin. Nephrol. 3:207, 1975.

[11] 11. CHARCOT, J. M. - Lecons sur les maladies du fois et des voies biliaires et des reins. Progrfcs Medical, Paris, 1877.

[12] 12. COOMES, E. N.; BERLYNE, G. M. & SHAW, A. B. - Incidence of neuropathy in non-dialysed chronic renal failure patients. In Proceedings of the European Dialysis and Transplant Association. Excerpta Medica, International Congress Series 2:138, 1965.

[13] 13. DAVISON, P. F. - Axoplasmic transport: physical and chemical aspects. In The Neurociences - 2nd. Study Program, Editado por Schmitt, F.O., Rockefeller Univ. Press, New York, 1970.

[14] 14. DAYAN, A. D.; GARDNER-THORPE, C.; DOWN, P. F & GLEADE, R. I. - Peripheral neuropathy in uremia. Neurology (Minneapolis) 20:649, 1970.

[15] 15. DYCK, F. J.; JOHNSON, W. J.; LAMBERT, E. H. & O'BRIEN, P. C. - Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin. Proc. 46:400, 1971.

[16] 16. FUNCK-BRENTANO, J. L.; CHAUMONT, P. & VANTELON, J. - Polynévrite au cours de l'uremie chronique: evolution aprés transplantation renal (10 observations personneles). Nephron 5:31, 1968.

[17] 17. GASSEL, M. M. - Sources of error in motor nerve conduction studies. Neurology (Minneapolis) 14:825, 1964.

[18] 18. GOODGOLG, J. & EBERTEIN, A. - Electrodiagnosis of Neuromuscular Disease. The Williams Wilkins Co., Baltimore, 1972.

[19] 19. HAUSMANOWA-PETRUSEWICZ, 1.; EMERYK, B. & LAO, H. - Analyse electromyographique de Thyperkeliemie dans l'insuffisance rénale. J. Electroenceph. Clin. Neurophysiol. Supl. 22:154, 1962.

[20] 20. JEBSEN, R, H. & TENCKHOFF, H. - Comparison of motor and sensory nerve conduction velocity in early uremic polyneuropathy. Arch. Phys. Med. & Rehab. 50:124, 1969.

[21] 21. JEBSEN, R. H.; TENCKHOFF, H. & HONET, J. C. - Natural history of uremic polyneuropathy and effects of dialysis. New Engl. J. Med. 277:327, 1967.

[22] 22. JENNEKENS, F. G. I.; MESS, E. J. D. & SPIJK, D. M. - Clinical aspects of uraemic polyneuropathy. Nephron 8:414, 1971.

[23] 23. KJELISTRAND, C. M.; PETERSEN, R. J.; EVANS, R. L.; SHIDMAN, J. R., von HARTITZSH, B. & BULSEMEYER, T. J. - A test of the "midler molecule hypothesis: Neuropathy in nephrectomized patients. Proc. Amer. Soc. Artif. Intern. Organs" XIX Anual Meeting, April 1973, Boston (Resumo).

[24] 24. KOMINAMI, N.; TYLER, R.; HAMPERS, C. L. & MERRIL, J. P. - Variation in motor nerve conduction velocity in normal and uremic patients. Arch. Intern. Med. 128:235, 1971.

[25] 25. KONOTEY-AHULU, F. I. D.; BAILLOD, R.; COMTY, C. M.; HERON, J. R.; SHALDON, S. & THOMAS, P. K. - Effect of periodic dialysis on the peripheral neuropathy of end-stage renal failure. Brit. Med. J. 2:1212, 1965.

[26] 26. LYNCH, P. G.; YUILL, G. W. & NICHOLSON, J. A. H. - Acute polyneuropathy complicating chronic renal failure. Nephron 8:278, 1971.

[27] 27. MAN, N. K.; TERLAIN, B.; PARIS, J.; WERNER, G.; SAUSSE, A. & FUNCK-BRENTANO, J. L. - An approach for "middle molecules" identification in artificial kidney dialysate: application to neuropathy prevention. Proc. Amer. Soc. Artif. Intern. Organs, XIX Annual Meeting, April 1973, Boston (Resumo).

[28] 28. McQUILLEN, M. P.; PROCOPIS, P. G. & LUKE, R. G. - Nerve excitability in chronic renal disease. Proc. Amer. Soc. Artif. Intern. Organs, XIX Annual Meeting, April 1973, Boston (Resumo).

[29] 29. MILLER, D. W.; NELSON, J. A. & BENDER, L. F. - Measurement of latency in facial nerve in normal and uremic persons. Arch. Phys. Med. & Rehab. 51:413, 1970.

[30] 30. NIELSEN, V. K. - Recovery from peripheral neuropathy after renal transplantation. Acta Neurol. Scand. 46:207, 1970, Supl. 43.

[31] 31. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: clinical symptoms and signs. Acta Med. Scand. 190:105, 1971.

[32] 32. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: inter-correlacion of clinical symptoms and signs and clinical grading of neuropathy. Acta Med. Scand. 190:113, 1971.

[33] 33. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: an analysis of the vitJratory perception thereshold. Acta. Med. Scand. 191:287, 1972.

[34] 34. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: sensory and motor conduction velocity. Acta Med. Scand. 194:445, 1973.

[35] 35. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: the relationship between sensory and motor nerve conduction and kidney function, azotemia, age, sex and clinical neuropathy. Acta Med. Scand. 194:455, 1973.

[36] 36. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: longitudinal course during terminal renal failure and regular hemodialysis. Acta Med. Scand. 195:155, 1974.

[37] 37. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: recovery after renal transplantation-clinical aspects. Acta Med. Scand. 195:163, 1974.

[38] 38. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: recovery after renal transplantation: electrophysiological aspects. Acta Med. Scand. 195:171, 1974.

[39] 39. NIELSEN, V. K. - The peripheral nerve function in chronic renal failure: decremental nerve conduction in uremia? Acta Med. Scand. 196:83, 1974.

[40] 40. OH, J. S.; CLEMENTS, R. S.; LEE, T. M. & DIETHELM, A. G. - Rapid improvement in nerve conduction velocity following renal transplantation. Ann. Neurology 4:369, 1978.

[41] 41. OSLER, W. - The Principles and Practices of Medicine. Appleton, New York, 1892.

[42] 42. PAKXENBERG, H.; CHRISTOFFERSEN, P.; NIELSN, B. & LARSEN, N. A. - Polyneuropathy in patients with uraemia treated with dialysis. Acta Neurol Scand. 46:206, 1970 (Supl. 43).

[43] 43. POPOVITZER, M. M.; ROSEBAUM, B. J.; GORDON, A. & MAXWELL, M. - Relief of uremic polyneyropathy after bilateral nephrectomy, New Engl. J. Med. 281:949, 1969.

[44] 44. PRESWICK, G. & JEREMY, D. - Subclinical polyneuropathy in renal insufficiency. Lancet 2:731, 1964.

[45] 45. QUINTON, W. E.; DILLARD, D. H.; COLLE, J. J. & SCRIBNER, B. H. - Eight months experiences with silastic-teflon bypass cannulas. Trans. Amer. Soc. Artif. Intern. Organs 7:136, 1961.

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[47] 47. RASKIN, N. H. & FISHMAN, R. A. - Neurologic disorders in renal failure. Ndw Engl. J. Med. 294:204, 1976.

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