1309 - Case Report: Multifactorial Neuropathic Pain seen in Chronic Kidney Disease and Cervical Stenosis

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MJ

Milap Joshi, DO

Resident Physician
Corewell Health Taylor Hospital
Dearborn, Michigan, United States

Co-Author(s)

PR

Philip Roskos, PhD

Director of Research
Corewell Health
Taylor, Michigan, United States
RA

Rizwan Alvi, MD

Attending Physician
Corewell Health Taylor Hospital
Taylor, Michigan, United States

Submitter(s)

MJ

Milap Joshi, DO

Corewell Health Taylor Hospital
Dearborn, Michigan, United States

Case Diagnosis: Neuropathic pain commonly reflects converging peripheral and systemic drivers rather than a single lesion. Interacting mechanisms such as ectopic firing, ion-channel remodeling, and central sensitization are all responsible for shaping a patient’s symptoms and their response to treatment.

Case Description: A 50-year-old woman presented with acute right-sided neck pain superimposed on chronic cervical and bilateral upper-extremity symptoms after missing several hemodialysis sessions. Admission studies showed marked electrolyte derangements (K 6.8 mEq/L, Na 134 mEq/L, HCO₃ 13 mEq/L) with azotemia (BUN 58 mg/dL, Cr 2.1 mg/dL). Cervical imaging demonstrated multilevel degenerative disc disease with canal stenosis and foraminal narrowing from C4-7. Neurosurgery recommended surgical intervention, however, following dialysis, patient preferred to be discharged after her pain and dysesthesia improved. She soon returned with recurrent neck pain, hand paresthesia, and weakness. She would then undergo an anterior cervical discectomy and fusion (ACDF) at C4-7 for decompression with neurosurgery. Postoperatively, patient’s radiculopathy symptoms had improved, but the neuropathic pain persisted in subsequent hospital admissions.

Discussions: This clinical course underscores the multifactorial nature of patient’s nerve pain. First, fixed structural pathology (cervical radiculopathy/myelopathy) likely warranted operative decompression. Second, systemic contributors possibly amplified or mimicked radicular symptoms: hyperkalemia and related electrolyte/acid-base disturbances can produce paresthesia and neuromuscular weakness that improve with correction or dialysis. Uremic toxin burden and inconsistent dialysis are linked to fluctuating neuropathic manifestations in advanced kidney disease patients. Accounting for spinal pathology and metabolic derangements explains why dialysis helped only partly, and why decompression could not fully resolve patient’s pain.

Conclusions: In summary, although ACDF was reasonable for progressive cervical radiculopathy, the patient’s nerve pain was likely multifactorial. Arising from cervical root/cord compression and potentiated by reversible dialysis-related electrolyte abnormalities. Overall, addressing metabolic factors alongside focal spinal pathology can help limit symptom intensity, sharpen prognostic expectations for decompression, and ultimately yield better outcomes.