Neurophysiologic changes in live related kidney transplant children and adolescents In adults involvement of the peripheral nervous system in chronic renal failure was described initially in the 19th century (1). In children this was reported recently (2). Uremic neuropathy is the most common type of peripheral nerve involvement and typically occurs when the cre- atinine clearance is less than 10 mL/min. It is a distal symmetrical sensorimotor neuropathy with the lower extremities more severely involved and characteristically having a stocking-glove distri- bution (3). As determined by the studies and careful clinical examination, evidence of periph- eral neuropathy is seen in 50–60% of adults with ESRD who require hemodialysis (4). The pre- valence of peripheral neuropathy in children is unknown for ESRD/dialysis patients. Successful renal transplantation in adults results in a substantial improvement in uremic polyneuropathy within weeks or months. Recov- ery occurs in two phases; phase I involves initial rapid improvement over days to weeks and phase II involves more protracted improvement over a period of months (5, 6). Side effects of immuno- suppressive therapy, especially cyclosporine, are some of the most common neurological problems encountered in the transplant recipient. Many are relatively minor, but others are more serious and should be recognized because they are El-Husseini AA, Abu-Hegazy M, El-Halim El-Tantawi A, Sobh MA, Ghoneim MA. Neurophysiologic changes in live related kidney trans- plant children and adolescents. Pediatr Transplantation 2005: 9: 579–583. Ó 2005 Blackwell Munksgaard Abstract: Uremic neuropathy is one of the most debilitating symptoms associated with end stage renal disease. In adults the only potential cure for uremic neuropathy is renal transplantation. No studies have inves- tigated the neurophysiologic abnormalities among pediatric renal transplant recipients. The objective of this study is to describe the incidence, nature and factors affecting neurophysiologic abnormalities in young renal transplant recipients. Neurophysiologic study was per- formed for 31 of our live related pediatric renal transplant recipients; they were 21 males and 10 females. The mean age at transplantation was 13.2 ± 3.1 yr. The neurophysiologic studies were performed at differ- ent time points after transplantation (range 12–60 months), with a mean period of follow-up after transplantation 3.2 ± 1.1 yr. Electromyog- raphy of the following muscles was tested: abductor pollicis brevis of the thenar eminence, biceps brachii, extensor digitorum brevis and rectus femoris. The median and lateral popliteal nerves were tested for esti- mating the motor conduction velocity. Neuropathic changes were found in 19% of our cases with more affection of the distal muscles of lower limbs. Motor conduction velocities were reduced, distal latencies were lengthened, and motor unit action potentials were reduced or dispersed. The predictors for development of neuropathy by multivariate analysis were the cumulative steroid dose and graft dysfunction. These results suggest that neuropathy is prevalent among young pediatric renal transplants. The independent predictors for development of neuropathy are graft dysfunction and anemia. It is unclear how significant these findings are in view of absent clinical signs and symptoms. This may represent an early stage of a disease that is still silent. Amr A. El-Husseini, Mohammad Abu-Hegazy, Abd El-Halim El-Tantawi, Mohamed A. Sobh and Mohamed A. Ghoneim Urology and Nephrology Center, Mansoura University, Egypt Key words: renal transplantation – children – neuropathy – electrophysiology – neurophysiology – kidney transplantation Dr. Amr A. El-Husseini, Lecturer of Nephrology, Urology and nephrology center, Mansoura University, Egypt Tel.: +20 50 221 9259 Fax: +20 50 226 3717 E-mail: amr_2000_2002@yahoo.com Accepted for publication 4 February 2005 Abbreviations: Cr. cl., creatinine clearance; EMG, elec- tromyography; ESRD, end stage renal disease; MUAP, motor unit action potentials; ms, milliseconds; NCV, nerve conduction velocity; S. cr., serum creatinine; SD, standard deviation. Pediatr Transplantation 2005: 9: 579–583 Copyright Ó 2005 Blackwell Munksgaard Pediatric Transplantation DOI: 10.1111/j.1399-3046.2005.00343.x 579