6/30/12

Skin Problems and Kidney Disorders (Renalife)

Skin Problems and Kidney Disorders

By Thomas Taylor, MD Chronic kidney disease, acute kidney failure, and end-stage renal disease have been associated with many distinctive skin problems. The exact names of each of these diseases is beyond the scope of this article. This discussion will be devoted to a general review of skin problems related to chronic renal failure in patients on dialysis and changes seen in patients who have had a kidney transplant. After chronic renal failure, a varied and complex involvement of many organ systems often occurs. The skin, hair and membranes may show important clinical signs as a first impression to the physician. Changes in the skin are usually marked. The skin is often pale which is related to secondary chronic anemia. A yellowish hue to the skin and dark hyperpigmentation to sun exposed areas have also been seen in many chronic renal patients. Extensive bruising of the skin, because of the problems with platelets and other hemostatic abnormalities, is often seen. Because of chronic dehydration, the patient's skin is usually dry and has a poor texture. Some patients experience firm plaques or nodules on the surfaces of the larger joints with a chalky material exuding because of calcium deposits in the skin. In chronic renal failure, patients may have finger or toenails consisting of approximately half the nails becoming white due to the chronic edema (swelling) of the nail bed; this is called half-and-half nails. A classic side effect of chronic end-stage renal disease is a uremia frost with white crystallized material found on the face and neck of a very ill patient. It is rarely seen today because of the improvement in treatment. A well dialyzed, healthy patient seldom experiences this. Generalized itching is one of the most important initial signs of chronic kidney disease. Of patients with end stage renal disease, 60 to 80 percent will experience problems with itching. It is also known that somewhere between 86 to 95 percent of patients on long-term dialysis have problems with itching. Dialysis patients have problems with excessively dry skin due to the decreased function of the oil glands. Treatment of the skin, for ESRD patients can be extremely difficult. Treatment of dry skin usually begins with the use of a hypo-allergenic soap, and avoiding long hot or warm baths. You should also avoid air drying of the skin. After towel drying, apply a thick, white moisturizer while the skin is still damp. The treatment is often extremely difficult and antihistamines are usually not effective. I have found that by appropriately managing the dry skin, the itching problems will markedly improve. Patients who receive kidney transplants are placed on immunosuppressant medications for long periods of time. Because of this, they have many problems with possible reactions to medications, infections and skin cancers. Skin infections with wart viruses, herpes viruses and impetigo are commonly seen. I believe that the dermatologist should be involved in the pretransplantation of patients with kidney failure to alert the patient to the many skin problems that will likely incur. I feel strongly that every patient with chronic skin disease, patients on renal dialysis or patients expecting a renal transplant need to be thoroughly educated about sun protection and to establish a skin examination procedure to prevent infections and skin malignancies. For people with specific infections or specific skin malignancies, they need to be diagnosed and treated appropriately. It is important to find a dermatologist with whom you feel comfortable. Make sure you see this specialist at least yearly or more as needed.

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