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Skin Disorders in Patients With Chronic Kidney Disease

Skin Problems in Chronic Kidney Disease: Sidebar: Key Points


Sidebar: Key Points

  • The treatment of uremic pruritus in patients with chronic kidney disease (CKD) is a difficult process of trial and error. Skin emollients, topical capsaicin and ultraviolet B phototherapy remain the first-line therapies, and systemic therapies such as gabapentin, activated charcoal and nalfurafine are reserved for therapy-resistant forms of uremic pruritus
  • The appearance.on the abdomen or other regions containing large amounts of subcutaneous fat.of livedo-reticularis-like skin lesions that turn into painful subcutaneous plaques or nodules, should raise clinical suspicion of calcific uremic arteriolopathy in a patient with CKD, particularly in the presence of additional risk factors such as obesity, diabetes, female sex and coumarin anticoagulation
  • The optimal treatment of calcific uremic arteriolopathy includes prompt and simultaneous initiation of aggressive wound care, antibiotics, optimization of dialysis therapy and rapid control of calcium and phosphate balance and secondary hyperparathyroidism; sodium thiosulfate and bisphosphonates can be administered concurrently in severe cases
  • Nephrogenic systemic fibrosis is highly suspected in a patient with CKD who has been exposed to gadolinium-based contrast agents and complains of painful tightening and swelling of the skin of the lower or upper extremities and has red or hyperpigmented skin plaques or nodules that become increasingly indurated
  • For patients with stages 4 and 5 CKD who require contrast-enhanced imaging, lowosmolar or iso-osmolar iodine-based contrast agents should be considered as an alternative to gadolinium-based contrast; if administration of gadolinium is absolutely necessary, use of low volumes of the more stable macrocyclic, ionic types of gadolinium-based contrast agent is advised
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