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Bilateral foot drop in a patient with kidney failure
I just saw a patient who is 29 y/o diagnosed with stage III kidney disease in 2022 then kidney failure that needed dialysis in June of 2023. In October 2024, he noticed numbness in both feet that rapidly progressed to just below the knees. In Feb 2025, he lost all kind of mobility around his ankles. He has floppy feet. DTRs are 2 + throughout including the knees while absent at the ankles. He tells me that he lost central vision in both eyes at the same time.
He had EMG by a neurologist with no sensory or motor responses in LE. Reduced amplitudes in upper. Diagnosed with severe neuropathy. The whole process was completely painless. MRI lumbar is unrevealing. Reveiwed his labs, all are ok except for very high Kappa, Lambda light chain. Faint band in the gamma region.
Etiology of kidney failure is not certain. It was thought that it is IgA nephropathy. Kidney biopsy was not helpful as it did not show any viable tissue to test (all scar tissue)
He is coming to see me as his Transplant team cancelled his kidney transplant that was scheduled for today because "rejection meds may worsen his neuropathy".
What do you think has happened. He has been stable since February. Nothing has changed. He gets peritoneal dialysis daily.
Thank you for your help
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