Polyneuropathy associated with chronic hemodialysis: Clinical and electrophysiological study.

AIM: To estimate the frequency and pattern of peripheral polyneuropathy (PNP) that may affect patients maintained on hemodialysis. PATIENTS AND METHODS: The study was carried out on 60 middle-aged male patients attending the Internal Medicine Department for maintenance hemodialysis. All were subjected to a complete neurological examination. Motor and sensory nerve conduction studies of both lower limbs (the tibial, peroneal and sural nerves) and both upper limbs (median and ulnar nerves), as well as F-wave measurements of both tibial and median nerves, were done. The patients were subdivided clinically into two groups, clinically apparent neuropathy and inapparent groups. Then they were divided according to the types of peripheral neuropathy detected by electrophysiological studies into axonal, demyelinated and mixed polyneuropathy. In addition, they were divided into motor, sensory and sensorimotor groups. RESULTS: Polyneuropathy was found clinically presented in 33 (55%) cases, while evident by electrophysiological examination in 100% of the clinically apparent group (33 patients) and evident in 92.5% of the clinically inapparent group (27 patients). The frequency of pathologic electrophysiological parameters was significantly higher in patients with longer duration of hemodialysis. Axonal polyneuropathy is the most prevalent type in those patients. CONCLUSION: Peripheral polyneuropathy is a common presentation in patients maintained on hemodialysis. The longer the duration of hemodialysis, the more liability to develop PNP that can be detected earlier by electrodiagnostic studies in the subclinical cases.

Prognostic significance of platelet count in SLE patients.

Hematological abnormalities, especially thrombocytopenia (TCP), are highly prevalent among patients with systemic lupus erythematosus (SLE) and at the same time it has been reported as a significant prognostic factor of SLE course. We further investigate the correlation between platelet count and the clinical manifestations and disease activity of SLE, in a cohort of Saudi Arabian female patients. A retrospective analysis was done for the medical records of 100 SLE female patients, selected from all patients diagnosed and treated for SLE at the Rheumatology outpatient clinics in Hera'a General Hospital, Holly Makkah, Saudi Arabia. The data collected from every patient's file included laboratory investigations (complete blood count, platelet parameters, ESR, anti-double-stranded DNA antibody, ANA), clinical manifestations, as well as SLE disease activity index (SLEDAI-2k) scores throughout a period of six sequential follow-up visits. Patients were divided into three groups according to the SLEDAI-2k: mild, moderate, and high-activity group. We found that, out of 100 patients, TCP was the most prevalent hematological abnormality evident in 15%, more than leucopenia (14%) and anemia (2%). TCP was acute in onset and associated with arthritis, neurologic manifestations, and nephritis. Platelet count showed a significant negative correlation with disease activity, in all of the three groups of patients. We concluded that platelet count has a negative correlation with disease activity in SLE patients, whatever the associated manifestations, and it should be considered as a prognostic factor, identifying patients with aggressive disease course.