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Cutaneous abnormalities in patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal dialysis may demonstrate signs of their underlying condition or reveal associated disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is integral to establishing a diagnosis, certain conditions will resolve o...
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... age 48 years), most commonly in the set- ting of diabetes mellitus or chronic renal failure (30). APD is characterized by scattered cone-shaped and plugged hyperkeratotic papules, plaques, and nodules in areas predisposed to superficial trauma and friction (e.g., extensors) (29). Lesions may be linearly arranged secondary to koebnerization (29) (Figs. 3 and 4). Severe pruritus is frequently reported ...
Citations
... Nail changes of a similar nature have been associated to a wide variety of diseases and disorders, such as Crohn's, Kawasaki, Behcet's, cirrhosis, zinc deficiency, pellagra, and HIV infection. On the other hand, it is a very reliable clinical indicator of end stage renal disease (9) . ...
... Sepsis from infection of cutaneous wounds is the leading cause of death in patients with calciphylaxis. 2 Calciphylaxis has a high risk of mortality; one-year mortality rates are widely variable, ranging from 45% to 80%. 2 Calciphylaxis is classically associated with chronic kidney disease (CKD), in particular endstage kidney disease (ESKD). [3][4][5] The largest nation-wide study to date estimates an incidence J o u r n a l P r e -p r o o f rate of 3.49 per 1,000 patient-years among patients on chronic hemodialysis for ESKD. 6 The incidence of calciphylaxis in this population has risen in the past decade. ...
Calciphylaxis is a life-threatening complication most often associated with chronic kidney disease that occurs due to the deposition of calcium in dermal and adipose microvasculature. However, this condition may also be seen in patients with acute kidney injury. The high morbidity and mortality associated with calciphylaxis highlight the importance to correctly diagnose and treat this condition. However, calciphylaxis remains a diagnosis that may be clinically challenging to make. Here, we review the literature on uremic calciphylaxis with a focus on its pathophysiology, clinical presentation, advances in diagnostic tools, and treatment strategies. We also discuss the unique histopathological features of calciphylaxis and contrast it with those of other forms of general vessel calcification. This review emphasizes the need of multidisciplinary collaboration including nephrology, dermatology, and palliative care to ultimately provide the best possible care to patients with calciphylaxis.
... They only way which can improve it is renal transplantation. [12,13] The absence of lunula is manifested by the nonvisual representation of the visible part of the nail matrix. ...
... PD grubunda tırnak bulgusu splinter hemoraji oranı HD grubundan anlamlı olarak daha yüksekti (p=0,017) (Tablo 3). Literatürde diyaliz tedavisi alan son dönem böbrek yetmezliği olan hastalarda ekimoz hem deride hem de oral mukozada sık gözlenen bir bulgu olarak belirtilmiştir 9 . Önelmiş ve ark %29, Mourad ve ark %47,3 oranında diyaliz hastalarında ekimoz rapor etmişlerdir 7,12 . ...
Amaç: Son dönem böbrek yetmezliği olan hastalarda primer hastalığa veya diyaliz tedavisine sekonder olarak mukokutanöz lezyonlar oldukça sık gözlenmektedir. Bu çalışmanın amacı, son dönem böbrek yetmezliği olup hemodiyaliz ve periton diyalizi alan hastaların dermatolojik bulgularını prevalansını saptamak ve 2 grup arası farkları karşılaştırmaktır. Yöntemler: Çalışmaya 49 hemodiyaliz (HD), 18 periton diyalizi (PD) alan 67 hasta kabul edildi. Yaş aralığı 20-90 arası idi. Hastaların medikal anamnezleri kaydedildi ve uygun ışık altında detaylı deri, saç, tırnak ve mukoza muayeneleri yapıldı ve bulgular kayıt altına alındı. Lüzum halinde lezyonlardan mikrobiyolojik ve histopatolojik ek incelemeler yapıldı. Bulgular: HD ve PD alan 2 grupta en sık gözlenen deri bulgusu kserosisdi. Ekimoz, HD alan grupta PD alan gruba göre anlamlı yüksek saptandı. Müköz bulgu olarak en sık HD grubunda paslı dil, PD grubunda kserostomi gözlendi. Her 2 grupta en sık görülen tırnak bulgusu yarım ve yarım tırnak idi. Splinter hemoraji HD grubunda, PD grubuna göre anlamlı yüksek saptandı. Hemodiyaliz grubunda saç bulgusu alt ekstremite kıl kaybı oranı periton diyaliz grubundan anlamlı olarak daha yüksekti. PD alan grupta en sık kafa derisinde kıl kaybı saptandı. Sonuç: Çalışmaya dahil edilen hastaların tümü en az bir dermatolojik bulgu göstermekte idi. HD ve PD alan 2 grupta mukokutanöz bulgular açısından minör farklılıklar saptandı.
... To the Editor: Dialysis for end-stage renal disease is associated with dermatologic conditions, including xerosis and uremic pruritus. 1 Patient education materials (PEMs) for chronic kidney disease are often presented above the average patient's literacy level. 2 Moreover, the readability of PEMs addressing cutaneous symptoms in patients undergoing dialysis is unknown. The National Institutes of Health recommends that PEMs should not surpass a sixthgrade level in readability, 3 and dermatologic PEMs often fail to meet this recommendation. ...
... On the one hand, children undergoing peritoneal dialysis had less skin moisture than those undergoing hemodialysis and healthy controls and there was a significant correlation between lower moisturizing of the stratum corneum and itching [19]. On the other hand, skin dryness may be influenced by race, accompanying illnesses, and various environmental factors [20]. Therefore, it seems as though the The exact role of divalent ions, as the cause of or as a related factor to severity uremic pruritus, has been a controversial issue. ...
Objective:
Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center.
Methods:
This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders.
Results:
Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman's rho = 0.42, P = 0.02) and serum level of parathyroid hormone (PTH) (Spearman's rho = 0.42, P = 0.04). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18).
Conclusion:
Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children.
... Brownish hairs that can be nodular or verrucous. This lesion can be accompanied by pruritus [39] Perforating folliculitis is another type of skin manifestation in hemodialysis patients in which degenerated follicles are destroyed along with collagen and elastic fibers, which of course can also be independent of collagen and elastic fibers. This disorder is clinically and histologically similar to other perforating disorders that also involve follicle involvement. ...
One of the notable points in ESRD patients is the multiplicity of skin manifestations which can include a wide range. It can also affect the living standards of patients due to its many types and severity. Careful study, as well as intense follow-up of these manifestations, can help physicians in timely diagnosis and their control or treatment. In this study, we tried to study the common mucocutaneous manifestations that occur in these patients. All references can be searched from PubMed. Sources of this study have been studied for clinical manifestations, pathophysiology, and treatment of skin manifestations in ESRD patients. In this study, xerosis, pruritus, pigmentation disorders, half and half nails, perforating disorder, and skin infections as well as appendageal disorders (hair and nail) in ESRD patients have been studied. These can be associated with other diseases and increase by disease severity. For better results and more help to patients with this disease, it seems that more and more comprehensive studies are needed. Key words: End stage renal disease, ESRD, mucucutaneous, skin, dermatology, xerosis, pigmentation disorders, infection, perforating disorder, half and half nails
... 4 Cutaneous manifestations are common in patients of ESRD either with or without hemodialysis (HD). 5 Pruritus, xerosis, nail and hair disorders, pallor, cutaneous infections and a number of other manifestations are believed to be independent of hemodialysis and acquired perforating dermatosis like calciphylaxis, nephrogenic fibrosing dermopathy, skin manifestations at fistula site and some bullous disorders are said to be present as complication of hemodialysis, 8 according to literature. It affects other organ systems but directly visible on skin either due to disease or its replacement HD therapy. ...
... Because a wide variety of skin alterations can present in patients with chronic kidney disease, the possible differential diagnoses to consider covers a large range of possibilities, particularly in the early stages of calciphylaxis in which the lesions are nonspecific. The entities to consider include: follicular hyperkeratosis, calcinosis cutis, peripheral arterial disease, pyoderma gangrenosum, vasculitis, warfarin-induced necrosis, non-uremic calcifying vasculopathy [15]. ...
... Xerosis (dry skin), is another common dermatological condition reported in patients with CKD [57,58] . The reduction of the eccrine sweat glands size and the atrophy of the sebaceous glands are assumed as the main reasons for xerosis [59] . ...
Almost 50–90% of chronic kidney disease patients undergoing haemodialysis have been reported to have Chronic kidney disease-associated pruritus (CKD-aP). The intensity of CKD-aP may vary from a mild itch to an unbearable pruritic sensation which interferes with the patient’s quality of life. CKD-aP has become one of the upmost distressing cutaneous and most common symptom of chronic kidney disease which is often overlooked by nephrologists, primary care physicians, and other health-care professionals. Typically sleep disorders, mental and social well-being have been correlated with chronic kidney disease patients. With that this article presents vital comprehensive review which includes epidemiology of chronic kidney disease in Malaysia and Pakistan, CKD-associated pruritus and other dermatological disorders associated with chronic kidney diseases, pathophysiology of CKD-associated pruritus, clinical features of chronic kidney disease-associated pruritus, diagnosis of CKD-associated uremic pruritus, differential diagnosis of CKD-associated uremic pruritus, assessment and quantification of pruritus severity.
