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Cutaneous Manifestations of Renal Disease

»	What types of skin changes are associated with renal disease?
»	What cutaneous findings occur in renal failure?
»	Do cutaneous signs of chronic renal failure resolve when the patient is treated with hemodialysis?
»	What cutaneous findings are present in patients being treated with dialysis?
»	Describe the nail changes in chronic renal failure.
»	What is uremic frost?
»	What causes the pallor of chronic renal failure?
»	What causes the pigmentary changes of the skin seen in chronic renal failure?
»	Is pruritus a common finding in all renal failure?
»	How is the pruritus of renal failure treated?
»	Are there skin changes associated with renal transplants?
»	What is transepidermal elimination? What is its relationship to kidney disease?
»	What are the differences between Kyrle’s disease, reactive perforating collagenosis, and perforating folliculitis?
»	Describe the porphyria-like eruption of dialysis.
»	What is Fabry’s disease?
»	Describe the skin lesions in Fabry’s disease.
»	What are the five vasculitic diseases that frequently involve both the kidneys and skin?
»	How should skin biopsy be used for the diagnosis of systemic amyloidosis?
»	What is nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy)?
»	What are some diseases that have both skin and renal manifestations?

Is pruritus a common finding in all renal failure?

No. Patients with acute renal failure do not develop pruritus. However, it is common in patients with chronic renal failure. Also, some patients with chronic renal failure treated with dialysis have exacerbation of their pruritus. The precise cause of uremic pruritus is unknown. One study suggests that uremic patients have a histamine-releasing factor in their sera that is depleted or diminished by ultraviolet B (UVB) light. Nitric oxide or pruritogenic cytokines may play a role in the pruritus of chronic renal failure. Another study found a reduction in the total number of skin nerve terminals in uremic patients and proposed that skin innervation is altered in chronic renal failure patients, possibly as a consequence of neuropathy. Secondary hyperparathyroidism, which sometimes develops in chronic renal failure, may also induce pruritus.

Goicoechea M, de Sequera P, Ochando A, et al: Uremic pruritus: an unresolved problem in hemodialysis patients, Nephron 82:73–74, 1999.

Urbonas A, Schwartz RA, Szepietowski JC: Uremic pruritus: an update, Am J Nephrol 21:343–350, 2001.