Cutaneous manifestations in chronic renal failure patients on hemodialysis and medical management
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20170432Keywords:
Chronic kidney disease, Cutaneous manifestations, DermatosesAbstract
Background: Over the past few decades, the developments in the field of Nephrology have improved the life expectancy of patients with chronic kidney disease (CKD). This situation provides more time for the dermatological conditions to manifest. The objective of the present study was to evaluate the different clinical patterns of cutaneous manifestations in chronic kidney disease and also to compare the cutaneous manifestations in CKD patients on dialysis and medical management.
Methods:. 120 consecutive cases of chronic kidney disease were included in the study. This included inpatients and outpatients, patients on medical management as well as those undergoing hemodialysis. A detailed history was taken and complete dermatological examination was performed. Digital photographs of skin lesions were taken. Relevant investigations like complete blood counts, blood urea, serum creatinine, serum electrolytes were performed routinely. Special investigations like KOH mount for fungus, Tzanck smear and skin biopsies were performed when clinically indicated.
Results: The number of cutaneous manifestations present in each patient is compared based on severity and duration of CKD. 82.8% of patients with severe CKD had more than one dermatoses compared to 60% of patients with mild CKD. So, multiple cutaneous manifestations could be found in the same patient, as the severity of CKD increases. Xerosis and hyperpigmentation were more prevalent in patients undergoing dialysis than those on medical management alone.
Conclusion: In patients with CKD xerosis, pruritus, pigmentation, nail changes and cutaneous infections were the predominant cutaneous manifestations. The prevalence of xerosis and hyperpigmentation were higher in patients with longer duration of disease and increased as the severity of CKD increased. The prevalence of pruritus was independent of the duration and severity of CKD.References
Nunley JR. Dermatologic manifestations of renal disease. E Medicine. 2002: 550.
Bargman JM, Skorecki K. Chronic Kidney Disease. Harrison's Principals of Internal Medicine. 17th edition. New York: McGraw Hill Co; 2008; 1761-1764.
Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant. 2005;20(8):1638-42.
Pico MR, Lugo-Somolinos A, Sanchez JL, Burgos-Calderon R. Cutaneous alterations in patients with chronic renal failure. Int J Dermatol. 1992;31(12):860.
Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int. 2006;70(12):2131-3.
EI Nahas AM, Wineares CG. Chronic renal failure. Oxford text book of medicine. 2002
Weatheral DJ, Ledingham JGG, Warsel DA. Oxford medical publications; 1996: 3294–3304.
Bhat R, Khaitan BK. Skin manifestations in internal diseases. IADVL Textbook and atlas of dermatology. 2nd edition. Mumbai: Bhalani Publishing House; 2001: 1347-1397.
Sultan MM, Mansour HH, Wahby IM, Houdery AS. Cutaneous manifestations in Egyptian patients with chronic renal failure on regular hemodialysis. J Egypt Women Dermatol Soc. 2010;7(1):49-55.
Kolla PK, Desai M, Pathapati RM, MastanValli B, Pentyala S, Madhusudhan Reddy G, et al. (2012). Cutaneous Manifestations in Patients with Chronic Kidney Disease on Maintenance Hemodialysis. ISRN Dermatol. 2012;2012:679619.
Hajheydari Z, Makhlough A. Cutaneous and mucosal manifestations in patients on maintenance hemodialysis. Iran J Kidney Dis. 2008;2:86-90.
Luqman N, Khalid M, Shaheen JA. Cutaneous manifestations of chronic renal failure in Bahawalpur, Pakistan. J Pak Assoc Dermatol. 2012;22(3):219-23.
Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereol Leprol. 2006;72(2):119-25.
