Treatment of porphyria cutanea tarda with phlebotomy in a patient on peritoneal dialysis

[Skin diseases in hemodialysis and kidney transplant patients]

Recently, the world is facing an escalate in the incidence of chronic kidney disease (CKD). Databases containing information about patients in end stage renal disease (ESRD), especially in the United States, were the sources of initial information about it. Brazil has the third largest population on dialysis in the world, and there are about 680 dialysis centers, spread across all units of the federation in the present, providing treatment to an estimated population of almost 90,000 patients. Cutaneous involvement in the chronic renal failure is characterized by a number of manifestations, which may be related to three processes: the primary renal disease, the uremic state, or the therapeutic measures used in their handling. The skin changes in these two classes of patients, dialysis and transplant recipients, have been the subject of several studies. n recent years, however, great progress has been achieved in these two therapeutic modalities, which may have changed not only the type of the dermatologic disorders associated with these two conditions, but also their intensity or frequency. This article aims to yield an update as to the topic skin diseases in hemodialysis and kidney transplant patients.

[Porphyria cutanea tarda in a dialyzed female patient]

Dermatological disorders are a frequent finding in patients with renal insufficiency. Porphyria cutanea tarda, pseudoporphyria, phototoxicity or concurrent bullous diseases may cause the appearance of lesions with liquid content in patients in dialysis. We describe the case of a female patient in dialysis who developed bullous lesions. The clinical and laboratory findings were initially compatible with the suspicion of pseudoporphyria, but the finding of some frankly elevated levels of porphyrins in serum, urine and feces confirmed the diagnosis of porphyria cutanea tarda. Porphyria cutanea tarda and pseudoporphyria present with common clinical manifestations. However, the levels of porphyrins in plasma, urine and feces in pseudoporphyria are normal or slightly elevated.

Porphyrie cutanée tardive chez un hémodialysé ayant une hépatite virale C : efficacité du traitement par petites phlébotomies

INTRODUCTION

Porphyria cutanea tarda (PCT) is a disorder of heme biosynthesis resulting from deficiency in the enzyme uroporphyrinogen decarboxylase. In the sporadic form of PCT, there are many agents that trigger the clinical manifestations.

EXEGESIS

We report a case of PCT in an hemodialysed patient with hepatitis C virus infection (HVC). He was treated with small repeated phlebotomies of 50 ml every week with photoprotection, eviction of traumatismes and inducing drugs. A clinical remission was induced after five months of treatment.

CONCLUSION

A proper diagnosis of PCT in non uremic hemodialysed patients requires fractionation of serum and fecal porphyrin changes. Management of this patients is difficult. Small repeated phlebotomies (50-100 ml) could be an interesting therapy.