You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.

Box 1.  

Skin Disorders in Patients With Chronic Kidney Disease

Skin Problems in Chronic Kidney Disease

Authors: Dirk R.J. Kuypers, MD, PhDFaculty and Disclosures


Summary and Introduction


Skin disorders associated with chronic kidney disease (CKD) can markedly affect a patient's quality of life and can negatively impact their mental and physical health. Uremic pruritus, which is frequently encountered in patients with CKD, is considered to be an inflammatory systemic disease rather than a local skin disorder. Biomarkers of inflammation are increased in patients with uremic pruritus and an imbalance of the endogenous opioidergic system might be involved in the complex pathogenesis of the disease. Treatment options for uremic pruritus include emollients, topical capsaicin cream, ultraviolet B phototherapy, gabapentin, oral activated charcoal and nalfurafine, a κ-opioid-receptor agonist. Calcific uremic arteriolopathy is triggered by an imbalance of promoters and inhibitors of vascular calcification, caused by the inflammatory changes that occur in uremia. Promising therapeutic strategies for calcific uremic arteriolopathy include bisphosphonates and intravenous sodium thiosulfate. Nephrogenic systemic fibrosis is a devastating condition associated with the use of gadolinium-based contrast agents in patients with CKD. At present, no therapies are available for this complication. Preventive measures include use of iodine-based contrast agents, particularly in patients with CKD stage 4 and 5. If gadolinium contrast is necessary, administration of low volumes of the more stable macrocyclic ionic types of gadolinium-based contrast agent is advocated. Hemodialysis following gadolinium exposure might offer benefits but evidence is lacking.


A wide variety of skin diseases occur in patients with chronic kidney disease (CKD; Box 1 ).[1-3] These diseases are sometimes related to the underlying renal illness but are more frequently directly or indirectly associated with 'uremia' in its broadest sense. With an almost 100% prevalence in dialysis populations, skin disorders are frequently the subject of patients' complaints.[1] A basic knowledge of the dermatological conditions that can arise in the setting of kidney disease is, therefore, very useful to practicing nephrologists. Skin diseases have a considerable negative effect on a patient's quality of life. They can induce serious discomfort, anxiety, depression and sleeping disorders and have an overall negative effect on mental and physical health. Although the majority of dermatological disorders in CKD are relatively benign, a few rare skin diseases have the potential to cause serious morbidity and mortality. Early recognition of these severe skin disorders and prompt initiation of treatment can dramatically alter their course and even save a patient's life. In this Review we discuss uremic pruritus (UP), an ongoing therapeutic challenge in patients with CKD. In addition, we discuss calcific uremic arteriolopathy (CUA) and nephrogenic systemic fibrosis (NSF), which are potentially dangerous skin diseases that require prompt clinical identification and treatment. Finally, acquired perforating dermatosis (Kyrle disease) and porphyria cutanea tarda are briefly described.

  • Print