Metabolic Neuropathies

Diabetic Neuropathy

Diabetes is the cause of the most common polyneuropa-thy seen by family physicians, occurring in up to 50% of all diabetic patients. Its incidence usually rises with disease progression. Diabetic peripheral neuropathy has a widely variable presentation but usually is seen as a symmetric polyneuropathy, with predominant sensory signs and mild motor signs. Patients experience burning dysesthesias and pain in the soles of the feet. Impaired position sense leading to ataxia and arthropathy (Charcot's joints) implies the involvement of large, myelinated, sensory fibers. Patients with diabetic neuropathy experience bilateral symptoms that include burning pain in the back and thigh with proximal muscle weakness, decreased patellar DTRs, and normal sensory function. This is thought to be caused by microvascular ischemia of the proximal motor trunks. Diabetes is also associated with autonomic neuropathies. Symptoms may include postural hypotension, gastropare-sis, intestinal dysmotility, atonic bladder, impotence, and loss of pain fibers in the cardiac sympathetic system, permitting silent MI.

Uremic Neuropathy

Patients with chronic renal disease develop a symmetric sensorimotor neuropathy involving the upper and lower extremities. They complain mostly of burning paresthesias. Uremic neuropathy is thought to be secondary to a toxic effect on the peripheral nerves. Because many chronic renal patients also have diabetes, it is often difficult to isolate a single cause. However, patients with true uremic neuropathy who have undergone renal transplantation can have dramatic improvement of symptoms (Rees, 1995).

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