Comparative study of cutaneous manifestations in patients with chronic kidney disease , patients on haemodialysis, and renal transplant recipients
More details
Hide details
Care Institute of Medical Sciences
rajitha muntha   

care institute of medical sciences, care hospital road no 10, banjara hills, 500034 hyderabad, India
J Pre Clin Clin Res. 2018;12(1):11–15
A wide variety of skin diseases occur in patients with chronic renal failure (CRF). These diseases are either related to the underlying chronic kidney disease (CKD) or to its treatment modalities like hemodialysis (HD) and renal transplant (RT). The studies comparing cutaneous manifestations in CKD, CKD with HD and RT recipients (RTR’s) have been limited.

Material and methods:
106 patients with CKD, 101 patients with CKD and who are undergoing HD and 80 RTR’s having at least one dermatological complaint formed the study groups. Detailed cutaneous examination was done for all patients and dermatological manifestations were compared among various study groups.

The most prevalent finding in CKD patients was xerosis (69%) followed by pruritus (67%) and pigmentation disorders (11%). Other cutaneous manifestations included acquired perforating diseases(APD) (7.5%); fungal (9.4%), viral (7%) and bacterial (2%) infections and nail changes(11%).The manifestations found in CKD patients on HD were xerosis (65%) followed by pruritus (62%),pigmentation disorders (20%), APD (6%); fungal (9.9%), viral (4%) and bacterial (5%) infections and nail changes(19%). In RTR’s, however, infections (47%) were the most prevalent finding. Others were xerosis(20%), pruritis(9%),pigmentation disorders(5%),APD (1%),nail changes(5%) and lesions of aesthetic interest(14%). Manifestations like pruritus, xerosis, hyperpigmentation and infections differed significantly when compared amongst three groups.

Cutaneous manifestations are common and different in CKD, HD and RTR group of patients. While xerosis and pruritus were common in CKD and HD group, infections were most prevalent in RTRs.

Udayakumar P, Balasubramanian S, Ramalingam KS, Chembolli Lakshmi, Srinivas CR, Anil C Mathew. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian Journal of Dermatology Venereology and Leprology 2006; 72(2): 119–25.
Singh G, Singh SJ, Chakrabarthy N, Siddharaju KS, Prakash JC. Cutaneous manifestations of chronic renal failure. Indian J Dermatol Venereol Leprol 1989; (55): 167–9.
George L, John GT, Jacob CK, Eapen P, Pulimood S, George R. Skin lesions in renal transplant recipients: A single center analysis. Indian Journal of Dermatology Venereology and Leprology 2009; 75(3): 255– 261.
Selvi GS, Kamalam A, Ajithdos K, Janaki C, Thambiah AS. Clinical and mycological features of dermatophytosis in renal transplant recipients. Mycoses 1999; (42): 75–8.
Chugh KS, Sharma SC, Singh V, Sakhuja V, Jha V, Gupta KL. Spectrum of dermatological lesions in renal allograft recipients in a tropical environment. Dermatology 1994; (188): 108–12.
Vijaykumar R, Fernando E, Rajendran S, Jayakumar M, Muthusethupathi MA. Dermatological manifestations in renal transplant recipients. TransplProc 1998; (30): 31–35.
Pradeep Arora, Mauro Verrelli. Chronic Renal Failure Medscape, Nephrology Updated: Feb 4, 2010.
Masson P, France L, Rodrignes. EEMCO guidance for the assessment of dry skin [xerosis] and ichthyosis: Clinic scoring systems. Skin research and technology 1995; 1(3): 109–114.
Gil Yosipovitch, Inbar Zucker, Geoffrey Boner, Uzi Gafter, Yonathan Shapira and Michae David. A Questionnaire for the Assessment of Pruritus: Validation in Uremic Patients, ActaDermVenereol 2001; 81: 108–111.
Cox NH, Coulson IH. Systemic Disease and the Skin. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rooks Textbook Of Dermatology. 8th ed. Wiley-Blackwell; 2010. p.62–74.
Saray Y, Seckin D, Gulec AT, Akgun S, Haberal M. Nail disorders in hemodialysis patients and renal transplant recipients: a case control study, JAAD 2004; 50(2): 197–202.
Johnson GA, Graham Brown RAC. The skin and disorders of the Alimentary tract, the Hepatobiliary system, Kidney and Cardiopulmonary System. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest AB, Leffell DJ, editors. Fitzpatricks Dermatology In General Medicine, 7th Edition. McGraw Hill; 2008 section 26. p. 1459–60.
Strumia R, Perini L, Tarroni G, Fiocchi O, Gilli P. Skin lesions in kidney transplant recipients. Nephron 1992; 62: 137–41.
Gilcherest BA, Rowe JW, Mihm MC. Clinical & histological skin changes in chronic renal failure. Evidence for a dialysis resistant, transplant responsive microangiopathy. Lancet 1980; 2: 1271–5.
Kato A. Pruritus and hydration state of stratum corneum in hemodialysis patients. American Journal of Nephrology 2000; 20: 437–42.
Stahle-Backdah M, Hagermark O, Lins Le. Pruritus in patients on maintenance hemodialysis. Acta Med Scand 1988; 224: 55–60.
Morton CA, Lafferty M, Hau C, Henderson I, Jones N, Lowe JG. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 1996; 11: 2031–2036.
Tawade N, Gokhale BB. Dermatologic manifestation of chronic renal failure. Indian J Dermatol Venereol Leprol. 1996; 62: 155–6.
Pico MR, Lugo Somohinos A. Cutaneous alterations in patients with chronic renal failure. International Journal of Dermatology. 1992; 31; 860–3.
Ponticelli C, Bencini PL. Uremic pruritus; a Review Nephron. 1992; 60(1): 1–5.
Annelies Avermaete, Peter Altmeyer, Martina Bachalach-Buhles. Skin changes in dialysis patients – A review. Nephrol dial Transplant.2001; 16: 2293–2296.
Wisgerhof HC, Edelbroek JR, DE Fijter JW, Feltkamp MC, Willemze R, Bouwes Bavinck JN. Trends of skin diseases in organ-transplant recipients transplanted between 1966 and 2006: A cohort study with follow-up between 1994 and 2006. Br J Dermatol. 2010 Feb 1; 162 (2): 390–6.
Gulec AT, Demirbilek M, Seckin D, Can F, Saray Y, Sarifakioglu E, et al. Superficial fungal infections in 102 renal transplant recipients: A case-control study. J Am Acad Dermatol 2003; 49: 104–14.