Cutaneous manifestations in patients with chronic renal failure(CRF) on hemodialysis
Background: Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. Aim: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis. Methods: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. Results: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%), followed by pallor (60%), pruritus (53%) and cutaneous pigmentation (43%). Other cutaneous manifestations included Kyrle's disease (21%); fungal (30%), bacterial (13%) and viral (12%) infections; uremic frost (3%); purpura (9%); gynecomastia (1%); and dermatitis (2%). The nail changes included half and half nail (21%), koilonychia (18%), onychomycosis (19%), subungual hyperkeratosis (12%), onycholysis (10%), splinter hemorrhages (5%), Mees' lines (7%), Muehrcke's lines (5%) and Beau's lines (2%). Hair changes included sparse body hair (30%), sparse scalp hair (11%) and brittle and lusterless hair (16%). Oral changes included macroglossia with teeth markings (35%), xerostomia (31%), ulcerative stomatitis (29%), angular cheilitis (12%) and uremic breath (8%). Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi's sarcoma were also observed. Conclusions: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.
Available from: Tushar J Vachharajani
- "The skin over both shins and left side of the face had scattered deposits of white, friable, crystalline material, with a " frosted " appearance  . These deposits were confluent in some areas and discrete in other (Figs 1, 2). "
Available from: PubMed Central
- "Our study showed the presence of xerostomia in 4.3% of dialysis patients and 21.5% of renal transplant recipients. This frequency is lower than the study conducted by Kho and associates (32.9%) as well as the study performed by Udayakumar and collegues (31%) [16,17]. Gingival enlargement (GE) was another oral lesion in 3.2% of renal transplant recipients and 1.1% of dialysis patients. "
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Renal transplantation is performed in patients with end stage renal disease as the best treatment plan. However, different complications may occur in these patients due to the direct consequences of the renal disease or drug-induced suppression of the body immune system. The main objective of the present study was to compare different oral lesions in patients receiving renal transplantation with the patients undergoing dialysis referred to two hospitals in Tehran, Iran.
Materials and Methods:
In this cross-sectional study, 93 renal transplant patients who had received renal transplant at least 6 months prior to our study, were selected from their records at the hospitals. Furthermore, 93 candidates of renal transplantation were selected as the control group. The patients in both case and control groups underwent oral examinations and the results were analyzed by chi-square test and Spearman correlation coefficient.
At least one oral lesion was found in 30 (32.2%) patients in the renal transplant group and 8 (8.6%) patents in the control subjects. The difference between the two groups was statistically significant (p<0.0001). The most prevalent lesion was xerostomia observed in 20 patients of the renal transplant group and 4 patients in the control group. The odds ratio of cyclosporine and amlodipine and the effect of these in increasing the risk of oral lesions was 1.21 and 1.02, respectively in renal transplant recipients.
The results of the study showed that renal transplantation significantly increases the risk of related oral lesions. Therefore, renal transplant recipients must undergo regular oral examinations in order to find any suspicious lesion(s) as soon as possible to treat them.
- "“Nephrogenic fibrosing dermopathy” and “bullous dermatoses of hemodialysis” develop only consequent to initiation of hemodialysis. Prolonged life-expectancy as a result of prompt treatment with hemodialysis enables newer cutaneous manifestations to appear. The advent of hemodialysis as the treatment of chronic renal failure (CRF) has virtually made uremic frost and erythema papulatum uremicum, the most frequent skin findings encountered in the predialysis era, extinct. "
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ABSTRACT: Chronic renal failure (CRF) is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities.
To evaluate the prevalence of various dermatoses in patients with CRF on hemodialysis and to study the effect of hemodialysis on the intensity of pruritus.
A total of 35 patients of CRF on hemodialysis having at least one cutaneous manifestation were included in the study.
Twenty-four (68.71%) cases in our study belonged to the age group of 50-69 years, out of which 16 cases were in the sixth decade. Xerosis and pruritus occurred in 80% and 65.71% of cases, respectively. Other common findings included pallor (68.57%), dyspigmentation (34.29%), cutaneous infections (34.39%), acquired perforating dermatosis (17.4%), and nail changes (60%). Hemodialysis failed to improve pruritus in 17 (73.9%) of our patients. Twenty-six patients (74.28%) suffered from hypertension, 13 of them also were known cases of type II diabetes mellitus. Five patients suffered exclusively from type II diabetes mellitus.
In our small study, xerosis was the commonest finding and pruritus, the commonest symptom. The intensity of pruritus was largely unaffected by hemodialysis.
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