ABSTRACT
Sensory aspects of uremic neuropathy were studied in 36 patients using clinical assessment and quantitative sensory tests (QST). The outstanding abnormality in sensory quality was perception of heat in response to low temperature stimuli. This paradoxical heat sensation was found in the foot in 42% (15) of patients, far beyond the normal prevalence of 10%. Paradoxical sensation was positively related to cold hypoesthesia (P = 0.0004) suggesting disinhibition as a possible mechanism. Paradoxical heat sensation also positively related to creatinine level (P = 0.0012). Pruritus was present in 20 patients (56%), intensity not related to any biochemical or clinical parameter. Signs of sensory polyneuropathy (PNP), based on at least two abnormal parameters in the clinical assessment or QST, were found in 39% of patients (14), of whom 11 had paradoxical heat sensation. Thus, in 4 patients (11%), this sensory aberration preceded other signs for PNP. Paradoxical heat sensation seems to be a common and often early expression of the sensory neuropathy in uremia.
Subject(s)
Hot Temperature , Kidney Failure, Chronic/physiopathology , Peripheral Nervous System Diseases/physiopathology , Sensation Disorders/physiopathology , Uremia/physiopathology , Adolescent , Adult , Aged , Female , Humans , Kidney Failure, Chronic/therapy , Lung Diseases, Obstructive , Male , Middle Aged , Peripheral Nervous System Diseases/etiology , Renal Dialysis , Sensation Disorders/etiologyABSTRACT
When severely dehydrated Bedouin goats were allowed to drink to satiation their plasma arginine vasopressin concentration immediately dropped from a value of 19.9 +/- 9.4 pmol.l-1 to 9.4 +/- 3.9 pmol.l-1 (P < 0.05). It continued to drop further until a concentration of 1.8 +/- 2.9 pmol.l-1 was recorded, similar to that reported for goats allowed to drink freely. When the goats were shown the water but drinking was denied, plasma arginine vasopressin immediately dropped to 11.7 +/- 4.0 pmol.l-1 (P < 0.05) and further decreased to 10.0 +/- 4.8 pmol.l-1 5 min following their sighting the water. This level, however, was not sustained and 2 h after the initial drop the high pre-trial concentration of plasma arginine vasopressin was regained. Presumably, sighting of water by dehydrated goats induces an abrupt drop in their plasma arginine vasopressin level even before drinking commences. When rehydrated, by introducing water directly to the rumen, circumventing both the sensing of the water and the drinking proper, no immediate drop in the plasma arginine vasopressin concentration of the newly rehydrated goats was observed. A delayed drop in the plasma arginine vasopressin levels took place slowly, concurrently with the drop in osmolality and concentration of Na+ in the plasma. It is suggested that sighting of water by dehydrated goats is involved in the modulation of plasma arginine vasopressin.
