Which neuropathy can occur in late CKD and its typical features?

• A. Ulnar neuropathy with wrist weakness.
• B. Uremic neuropathy with numbness, paresthesias, or reduced reflexes.
• C. Diabetic neuropathy with burning pain.
• D. Bell’s palsy.

Answer: (B)

In late chronic kidney disease, uremic neuropathy is the neuropathy you’d expect to see. It’s a distal symmetric sensorimotor polyneuropathy caused by the buildup of uremic toxins, so it tends to affect the feet first and then the hands in a stocking-glove pattern. Typical features include numbness and paresthesias, with reduced reflexes on exam—especially the ankle reflexes—reflecting both sensory loss and emerging motor involvement as it progresses. This neuropathy often improves when kidney function is supported by dialysis or transplantation, underscoring its link to toxin accumulation.

Ulnar neuropathy with wrist weakness would present as a focal nerve problem, not a diffuse, symmetric picture related to kidney failure. Diabetic neuropathy can include burning pain but isn’t specifically tied to late CKD and is not the defining CKD-related neuropathy. Bell’s palsy involves a peripheral facial nerve palsy, unrelated to CKD.