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Vieira ÉC, Marcolino MS, Guedes ACM, Maciel MMMD, dos Santos WF, Pimentel LCF, Gomes PR, Bressan A, Farah KDP, Araújo MG. Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study. SAO PAULO MED J 2024; 142:2023148. [PMID: 38422240 PMCID: PMC10885634 DOI: 10.1590/1516-3180.2023.0148.r1.29112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.
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Affiliation(s)
- Érica Cristina Vieira
- MD, Masters Student. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais / Empresa Brasileira de Serviços Hospitalares (UFMG/EBSERH) Belo Horizonte (MG), Brazil
| | - Milena Soriano Marcolino
- MD, PhD. Associate Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; Coordinator of Scientific Division, Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Antônio Carlos Martins Guedes
- MD, PhD. Dermatologist. Attending Physician, Dermatology Outpatient Clinic Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | | | - Wandilza Fátima dos Santos
- MD. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Luciana Consoli Fernandes Pimentel
- MD. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Paulo Rodrigues Gomes
- Masters Student. Analyst Programmer, Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Anita Bressan
- Medical Student, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Kátia de Paula Farah
- PhD. Associate Professor Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil Nephrology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Marcelo Grossi Araújo
- PhD. Associate Professor, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; Leprosy Clinic Coordinator. Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Alenzi F. Reactive perforating collagenosis and systemic lupus erythematosus: A rare case report. Medicine (Baltimore) 2022; 101:e32138. [PMID: 36482516 PMCID: PMC9726282 DOI: 10.1097/md.0000000000032138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Transepidermal clearance of altered collagen and excessive excretion of keratin are characteristics of a rare cutaneous disorder known as reactive perforating collagenosis (RPC). There are different forms of RPC; however, the acquired form is the most prevalent and inherited. Reactive perforating collagenosis is rarely described in autoimmune rheumatic diseases; instead, it is typically linked to systemic conditions such as renal failure or hepatic disease. METHODS A 31-year-old Saudi female patient who was initially diagnosed with undifferentiated connective tissue disease. She developed RPC with a severe diffuse itchy skin rash with numerous papules and nodules with central hyperkeratotic plugs over the lower limb, upper limb, and face. RESULTS The patient tested positive for antinuclear antibody; however, a year later, patient developed Raynaud's phenomenon, oral and nasal ulcers, malar rash, fatigue, and lupus rash around her eyes, and systemic lupus erythematosus was diagnosed clinically. The patient was treated for reactive perforating collagenosis with systemic antihistamines (diphenhydramine 50 mg orally twice daily), topical steroid cream (betamethasone dipropionate cream), and oral isotretinoin (20 mg daily). The patient was advised to undergo phototherapy. A year later, she presented with symptoms of systemic lupus erythematosus and started taking oral hydroxychloroquine 200 mg twice daily for systemic lupus erythematosus. The patient is listed on follow-up. CONCLUSION Variable skin rash can mimic systemic lupus erythematosus and vasculitis. Therefore, reactive perforating collagenosis is a skin condition that requires high clinical suspension for diagnosis, and it might be challenging to determine whether it is an association or a complication. Furthermore, the timing of the skin biopsy may be crucial for the diagnosis of reactive perforating collagenosis.
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Affiliation(s)
- Fahidah Alenzi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- * Correspondence: Fahidah Alenzi, Clinical Sciences Department -College of medicine, Princess Nourah bint Abdulrahman University (e-mail: )
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Pratyusha K, Dawman L, Vinay K, Tiewsoh K, Sharawat IK. Dermatological manifestations in children with chronic kidney disease: a study from a North Indian tertiary care institute. Clin Exp Dermatol 2021; 46:1270-1276. [PMID: 33904201 DOI: 10.1111/ced.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatological manifestations due to impaired renal function in children with chronic kidney disease (CKD) are diverse and are an important cause of morbidity. AIM To determine the prevalence of dermatological manifestations in predialysis children with different stages of CKD and its association with various metabolic parameters. METHODS This cross-sectional observational study was conducted in 200 predialysis children with CKD stages 1-5 and 200 age- and sex-matched healthy controls (HCs). Detailed dermatological examination was performed to check for any pathological/physiological changes in the skin, mucosa, hair and nails, and changes were recorded in a predesigned proforma. RESULTS The median age of cases and HCs was 60.50 months (76.5% males) and 62 months (78.5% males) respectively. Skin manifestations were seen in 189 (94.5%) cases and 156 (78%) HCs (P < 0.001). The most common skin manifestation among cases was pallor (75.5%, P < 0.001) followed by xerosis (48.5%, P < 0.001), atopic diathesis (41.5%) and pruritus (13%, P < 0.001), while among HCs, the most common skin manifestation was atopic diathesis (46%), followed by pallor (24%) and xerosis (14%). Xerosis was found to be significantly associated with higher serum creatinine levels (P = 0.04) and hypocalcaemia (P = 0.03). There was no significant association found between pruritus and serum creatinine. CONCLUSION Xerosis was significantly associated with higher levels of creatinine and hypocalcaemia. Timely recognition of these symptoms and proper management can improve the quality of life in children with CKD.
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Affiliation(s)
- K Pratyusha
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - L Dawman
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Vinay
- Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Tiewsoh
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - I K Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
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Goel V, Sil A, Das A. Cutaneous Manifestations of Chronic Kidney Disease, Dialysis and Post-Renal Transplant: A Review. Indian J Dermatol 2021; 66:3-11. [PMID: 33911288 PMCID: PMC8061480 DOI: 10.4103/ijd.ijd_502_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Skin serves as the mirror of underlying systemic problems. The early diagnosis of subtle cutaneous clinical pointers often helps in identifying renal disorders, obviating the delay in diagnosis and treatment. Cutaneous changes can be observed from the beginning of renal impairment until the evolution to terminal stage, in uremia, hemodialysis, and after kidney transplantation. In the review, we have discussed the cutaneous changes, its implicated etiopathogenesis, and their treatment options, as encountered in chronic kidney disease, hemodialysis and post-renal transplantation.
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Affiliation(s)
- Vivek Goel
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Abheek Sil
- Department of Dermatology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Pérez Pico AM, Dorado P, Santiesteban MÁ, Mingorance-Alvarez E, García-Bernalt Funes V, Mayordomo R. Prevalence of foot disorders according to chronic kidney disease stage. J Ren Care 2020; 47:17-26. [PMID: 33216453 DOI: 10.1111/jorc.12342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a public health disease that affects 15.1% of the adult population. Although a high prevalence (94.1%) of skin disorders has been detected in people on haemodialysis or with advanced CKD, few studies have analysed foot disorders at initial CKD stages. OBJECTIVES To analyse the prevalence of foot disorders according to CKD stage. PARTICIPANTS A total of 209 people with a mean age of 73.2 ± 13.8 years (52.0% women) in the nephrology department of Virgen del Puerto Hospital, Plasencia (Spain) were examined from January 2018 to April 2019. MEASUREMENTS CKD stages were determined by nephrologists according to the Kidney Disease Improving Global Outcomes Guideline. An expert podiatrist identified foot disorders. Data were statistically treated with the IBM SPSS Statistics. Comparisons between variables were analysed by the χ2 test or Fisher's exact test, with a significance level of less than 5%. RESULTS The prevalence of foot disorders was high for skin disorders (97.6% dermatopathies and 66.0% keratopathies), nail disorders (98.5% onychopathies) and toe deformities (97.1%). People at initial and intermediate stages presented more keratopathies (hyperkeratosis at G1 and G3a and pinch callus at G3a). Stage G1 showed fewer changes in nail colour and half and half nails. Stage G4 showed more claw toes and hematoma and stage G5 more Beau's lines, changes in skin colour, hematomas and thin shiny skin. CONCLUSIONS The high prevalence of foot disorders detected in people with CKD requires specific and personalised professional care to relieve symptoms and avoid complications, helping to improve the quality of life of people with this condition.
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Affiliation(s)
- Ana M Pérez Pico
- Department of Nursing, University of Extremadura, Plasencia, Spain
| | - Pedro Dorado
- Department of Medical and Surgery Therapy, University of Extremadura, Plasencia, Spain.,University Institute of Biosanitary Research of Extremadura (INUBE), Universidad de Extremadura, Badajoz, España, Spain
| | - Miguel Á Santiesteban
- Department of Nephrology, Virgen del Puerto Hospital, Servicio Extremeño de Salud, Plasencia, Spain
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Morillo Gallego N, Merino Martínez RM, Sánchez Cabezas AM, Alcántara Crespo M. Alteraciones de la piel del paciente con enfermedad renal crónica avanzada. Una revisión sistemática. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objetivo: Conocer las principales alteraciones de la piel, así como su prevalencia, en los pacientes con Enfermedad Renal Crónica Avanzada.
Material y Método: Se ha realizado una revisión sistemática a través de las bases de datos de PubMed, Cochrane, Scopus y Google Académico. Se incluyeron artículos científicos escritos en inglés y español. Se analizaron los artículos que trataban sobre las alteraciones en la piel en el paciente con Enfermedad Renal Crónica Avanzada y/o en tratamiento con diálisis.
Resultados: Se han incluido 32 artículos publicados entre el año 2008 y 2018: 7 revisiones sistemáticas, 3 de tipo experimental y 22 de tipo observacional. Las alteraciones cutáneas aparecen en la mayoría de los pacientes en prediálisis y en tratamiento con diálisis, en mayor o menor grado. La mayoría de alteraciones de la piel descritas han sido, xerosis, prurito e hiperpigmentación. La mayor complicación relacionada con la alteración de la piel ha sido la calcifilaxis; siendo las variables más influyentes en la aparición de estas lesiones, el tipo de tratamiento dialítico, las enfermedades asociadas y falta de adherencia a la dieta prescrita.
Conclusiones: Las alteraciones en la piel están presentes en la mayoría de los pacientes con Enfermedad Renal Crónica Avanzada y en diálisis, predominando la xerosis como la alteración más frecuente, siguiéndole el prurito y la hiperpigmentación. La complicación más grave relacionada con las alteraciones de la piel es la calcifilaxis, encontrándose asociada a altos niveles de fósforo sérico. No existen protocolos estandarizados para el manejo de las alteraciones cutáneas en estos pacientes.
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Jazani NH, Savoj J, Lustgarten M, Lau WL, Vaziri ND. Impact of Gut Dysbiosis on Neurohormonal Pathways in Chronic Kidney Disease. Diseases 2019; 7:diseases7010021. [PMID: 30781823 PMCID: PMC6473882 DOI: 10.3390/diseases7010021] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/29/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is a worldwide major health problem. Traditional risk factors for CKD are hypertension, obesity, and diabetes mellitus. Recent studies have identified gut dysbiosis as a novel risk factor for the progression CKD and its complications. Dysbiosis can worsen systemic inflammation, which plays an important role in the progression of CKD and its complications such as cardiovascular diseases. In this review, we discuss the beneficial effects of the normal gut microbiota, and then elaborate on how alterations in the biochemical environment of the gastrointestinal tract in CKD can affect gut microbiota. External factors such as dietary restrictions, medications, and dialysis further promote dysbiosis. We discuss the impact of an altered gut microbiota on neuroendocrine pathways such as the hypothalamus⁻pituitary⁻adrenal axis, the production of neurotransmitters and neuroactive compounds, tryptophan metabolism, and the cholinergic anti-inflammatory pathway. Finally, therapeutic strategies including diet modification, intestinal alpha-glucosidase inhibitors, prebiotics, probiotics and synbiotics are reviewed.
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Affiliation(s)
- Nima H Jazani
- Division of Nephrology, Department of Medicine, University of California-Irvine, Irvine, CA 92697, USA.
| | - Javad Savoj
- Department of Internal Medicine, Riverside Community Hospital, University of California-Riverside School of Medicine, Riverside, CA 92501, USA.
| | - Michael Lustgarten
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
| | - Wei Ling Lau
- Division of Nephrology, Department of Medicine, University of California-Irvine, Irvine, CA 92697, USA.
| | - Nosratola D Vaziri
- Division of Nephrology, Department of Medicine, University of California-Irvine, Irvine, CA 92697, USA.
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Asayesh H, Peykari N, Pavaresh-Masoud M, Esmaeili Abdar M, Tajbakhsh R, Mousavi SM, Djalalinia S, Noroozi M, Qorbani M, Mahdavi-Gorabi A. Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta-analysis. J Cosmet Dermatol 2018; 18:204-211. [PMID: 29577562 DOI: 10.1111/jocd.12531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.
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Affiliation(s)
- Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Niloofar Peykari
- Iranian Non-communicable Diseases Committee, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Mohammad Esmaeili Abdar
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ramin Tajbakhsh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Chronic Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Armita Mahdavi-Gorabi
- Department of Basic and Clinical Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R, Sharma V. Mucocutaneous Manifestations in Patients with Chronic Kidney Disease: A Cross-sectional Study. Indian Dermatol Online J 2018; 9:20-26. [PMID: 29441293 PMCID: PMC5803936 DOI: 10.4103/idoj.idoj_160_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Chronic kidney disease (CKD)-associated mucocutaneous manifestations significantly impair the quality of life but often remain understudied. They may also vary across regions, socioeconomic and nutritional status, and racial differences. Objectives: To study the patterns of mucocutaneous disorders and their prevalence in CKD patients irrespective of clinical stage or dialysis status. Materials and Methods: 122 (M:F = 77:45) patients aged 21‒85 (Mean ± SD = 57.5 ± 14.0) years having CKD for 3 month to 5 years were studied for mucocutaneous manifestations. Fifty (41%) patients were on hemodialysis for 1‒42 months. Detailed medical history, clinical and mucocutaneous examination, and lab investigations were performed. KOH mounts, skin biopsy, Gram's and Giemsa staining, bacterial or fungal cultures were performed as required. Results: Xerosis in 93 (76.2%), skin pallor in 61 (50%), pruritus in 57 (46.7%), pigmentation in 47 (38.5%), and purpura in 18 (14.8%) patients were the major dermatoses. Bullous lesions and perforating folliculitis occurred in 3 (2.5%) patients each. Major nail abnormalities were pallor (in 35.2%), absent lunula (in 23.8%), nail discoloration (in 18%), and “half-and-half nails” in 16.4% patients, respectively. Hair abnormalities included sparse scalp and body hairs (in 35.2% and 13.1%, respectively) and lusterless hair in 12.3% patients. Coated tongue (in 14.8%), xerostomia (in 12.3%), and macroglossia with teeth indention (in 7.4%) patients were the mucosal manifestations. Conclusions: Xerosis, pruritus, skin pallor/pigmentary changes, nail pallor, absent lunula, nail discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in the studied patients irrespective of hemodialysis status. Cold and dry climates might be additional aggravators for xerosis/pruritus. Lifelong follow-up may be needed to reduce the morbidity associated with CKD/hemodialysis specific dermatoses appearing over a period.
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Affiliation(s)
- Rattan S Rashpa
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Pankaj Kumar
- Department of Internal Medicine, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Ritu Rawat
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
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da Silva Júnior G, Nogueira Farias G, Pinto J, Melo J, Fernandes Távora L, Lima D, Viana Correia F. Kyrle's disease associated with HIV infection, diabetes, and chronic kidney disease. INDIAN J PATHOL MICR 2018; 61:414-417. [DOI: 10.4103/ijpm.ijpm_532_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Solak B, Acikgoz S, Sipahi S, Erdem T. Cutaneuos findings in patients with predialysis chronic kidney disease. J Eur Acad Dermatol Venereol 2016; 30:1609-13. [DOI: 10.1111/jdv.13643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B. Solak
- Department of Dermatology; School of Medicine; Sakarya University; Sakarya Turkey
| | - S.B. Acikgoz
- Department of Internal Medicine; School of Medicine; Sakarya University; Sakarya Turkey
| | - S. Sipahi
- Division of Nephrology; Department of Internal Medicine; School of Medicine; Sakarya University; Sakarya Turkey
| | - T. Erdem
- Department of Dermatology; School of Medicine; Sakarya University; Sakarya Turkey
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Epidemiology and determinants of pruritus in pre-dialysis chronic kidney disease patients. Int Urol Nephrol 2016; 48:585-91. [PMID: 26762886 DOI: 10.1007/s11255-015-1208-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/28/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE There are only a few small studies investigating chronic kidney disease-associated pruritus (CKD-P) in pre-dialysis chronic kidney disease (CKD). None of these has taken into account the associations of CKD-P with clinical features and laboratory data. We aimed to study prevalence of and clinical and laboratory associates of CKD-P in pre-dialysis CKD patients. METHODS A total of 402 consecutive stage 2-5 pre-dialysis CKD patients were included in this cross-sectional study. Pruritus was scored based on visual analog scale (VAS). Demographic and clinical features, comorbidities, smoking status and current medication use were recorded. 25 (OH) Vitamin D, urea, creatinine, uric acid, calcium, phosphorus, intact parathyroid hormone (PTH), magnesium, albumin, C-reactive protein (CRP), complete blood count and differential and other laboratory tests were studied for each participant. RESULTS This is the largest study conducted in pre-dialysis population with respect to pruritus and associated factors. The prevalence of CKD-P was 18.9%. Hemoglobin level was significantly lower, and eosinophil count and frequency of xerosis cutis were significantly higher in patients with CKD-P than those of patients without pruritus. However, there was no statistical difference between the pruritus and nonpruritus groups regarding vitamin D, PTH, calcium, phosphorus, neutrophil-to-lymphocyte ratio (NLR) and CRP. CONCLUSIONS CKD-P was almost present in one in every five pre-dialysis CKD patients. Interestingly, the prevalence was not affected by the stage of the CKD. For the first time, our results showed a significant association between CKD-P and peripheral eosinophilia and anemia. Besides this, xerosis cutis seems a determinant factor for CKD-P and its severity.
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Saardi KM, Schwartz RA. Uremic frost: a harbinger of impending renal failure. Int J Dermatol 2015; 55:17-20. [DOI: 10.1111/ijd.12963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 12/16/2014] [Accepted: 12/31/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Karl M. Saardi
- Dermatology; Rutgers University New Jersey Medical School; Newark NJ USA
| | - Robert A. Schwartz
- Dermatology; Rutgers University New Jersey Medical School; Newark NJ USA
- Pediatrics, Medicine, Pathology, and Preventive Medicine and Community Health; Rutgers University New Jersey Medical School; Newark NJ USA
- Rutgers University School of Public Affair and Administration
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Disturbed skin barrier in children with chronic kidney disease. Pediatr Nephrol 2015; 30:333-8. [PMID: 25127919 PMCID: PMC4282711 DOI: 10.1007/s00467-014-2932-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are limited data on skin lesions in children with end-stage renal failure. The aim of the study was an evaluation of the skin barrier in children with different stages of chronic kidney disease (CKD). The prevalence of xerosis, its severity, as well as its link selected demographic factors, were examined. METHODS The study included 103 children: 72 with CKD stages 3-5 (38 on conservative treatment and 34 on dialysis) and 31 patients with primary monosymptomatic nocturnal enuresis as a control group. Initially, the study subjects described the localisation and severity of dry skin by themselves. Next, clinical evaluation of xerosis, non-invasive corneometric assessment of epidermis moisturising and the measurement of transepidermal water loss were performed. RESULTS Most CKD children reported dry skin. The problem of xerosis was identified more frequently in patients on dialysis (67.6 %) than on conservative treatment (42.1 %) (p = 0.01). CKD patients divided according to skin dryness did not differ with regards to age, sex, initial kidney disease and CKD duration. CONCLUSIONS Disturbed skin barrier is an important concern of children with CKD, intensifying as the disease progresses. This symptom occurs on early stages of CKD and it should be taken into consideration in the CKD management.
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Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol 2014; 7:313-9. [PMID: 25419152 PMCID: PMC4235205 DOI: 10.2147/ccid.s70842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Patients and methods Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. Results This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Conclusion Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.
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Affiliation(s)
- Basma Mourad
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Doaa Hegab
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Kamal Okasha
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Böhme T, Heitkemper T, Mettang T, Phan N, Ständer S. Klinische Charakteristika und Prurigo nodularis bei nephrogenem Pruritus. Hautarzt 2014; 65:714-20. [DOI: 10.1007/s00105-014-2756-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dahbi N, Hocar O, Akhdari N, Amal S, Bassit N, Fadili W, Laouad I. [Cutaneous manifestations in hemodialysis patients]. Nephrol Ther 2014; 10:101-5. [PMID: 24508001 DOI: 10.1016/j.nephro.2013.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/21/2013] [Accepted: 10/13/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hemodialysis patients have frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. The objective was to evaluate the prevalence and nature of cutaneous lesions associated with CRF patients on hemodialysis patients. PATIENTS AND METHODS Transversal and observational study of 53 patients with CRF on regular hemodialysis. RESULTS There were 28 women and 25 men. Their mean age was 44 year-old. All patients had cutaneous manifestations and 64% complained of dermatological signs. Cutaneous xerosis and pigmentation disorders were found in 96 and 94% of patients, respectively. Other manifestations were pallor (41%), pruritus (20.7%), a diffuse hair loss (35.8%) and nails changes (66%). COMMENTS Cutaneous manifestations in hemodialysis patients are frequent polymorphous. Their incidence varies from 50 to 100% of the series. Their knowledge deserves a proper management by both dermatologists and nephrologists to improve the life quality of hemodialysis patients.
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Affiliation(s)
- Noama Dahbi
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc.
| | - Ouafa Hocar
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nadia Akhdari
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Said Amal
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nora Bassit
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Wafaa Fadili
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Inas Laouad
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
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Ataseven A, Ozturk P, Kucukosmanoglu I, Kurtipek GS. Kyrle's disease. BMJ Case Rep 2014; 2014:bcr-2013-009905. [PMID: 24429045 DOI: 10.1136/bcr-2013-009905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kyrle's disease (KD) is a dermatosis which was first described by Kyrle as "hyperkeratosis follicularis et parafollicularis in cutem penetrans" in 1916. Perforating dermatoses are a heterogeneous disorder group characterised by transepithelial elimination. KD has been seen in association with multiple disorders, including diabetes mellitus, renal and liver diseases, congestive heart failure, hyperlipidaemia, infective diseases and abnormal metabolism of vitamin A. This case report presents two patients with KD with associated systemic disease.
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