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Alnoshan AA, Alrashdi FH, AlDahash RA, Nagshabandi KN, Alotaibi S. Unexpected Repigmentation of Vitiligo Universalis Following Hemodialysis Initiation: A Rare Case Report and Literature Overview. Clin Cosmet Investig Dermatol 2024; 17:2519-2522. [PMID: 39534791 PMCID: PMC11556327 DOI: 10.2147/ccid.s482396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/16/2024] [Indexed: 11/16/2024]
Abstract
Vitiligo is a chronic skin depigmentation disorder affecting 0.2-1.8% of the global population, with a significant prevalence in Saudi Arabia. Although not life-threatening, it severely impacts the quality of life and psychological well-being of patients. We report a rare instance of hemodialysis-induced skin repigmentation involving a 25-year-old woman with vitiligo universalis.
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Affiliation(s)
| | | | | | | | - Salman Alotaibi
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
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2
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Rekik M, Sellami K, Baklouti M, Bahloul E, Mesrati H, Turki H. [Repigmentation in vitiligo universalis triggered by hemodialysis]. Nephrol Ther 2021; 17:473-474. [PMID: 34059479 DOI: 10.1016/j.nephro.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Vitiligo is an acquired depigmenting disorder. Vitiligo universalis is a rare form responsible for significant aesthetic damage. To date, the exact pathogenesis remains unknown. Its treatment, a real challenge, consists rather in removing the still pigmented areas. We report a case of a patient followed for stable vitiligo universalis from an early age who presented with repigmentation shortly after initiation of hemodialysis.
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Affiliation(s)
- Mariem Rekik
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie.
| | - Khadija Sellami
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Massara Baklouti
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Emna Bahloul
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Hela Mesrati
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Hamida Turki
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
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Kalantari S, Nafar M. An update of urine and blood metabolomics in chronic kidney disease. Biomark Med 2019; 13:577-597. [DOI: 10.2217/bmm-2019-0008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Chronic kidney disease is considered as a serious obstacle in global health, with increasing incidence and prevalence. In spite of numerous attempts by using recent omics technologies, specially metabolomics, for understanding pathophysiology, molecular mechanism and identification reliable consensus biomarkers for diagnosis and prognosis of this complex disease, the current biomarkers are still insensitive and many questions about its pathomechanism are still to be unanswered. This review is focused on recent findings about urine and serum/plasma metabolite biomarkers and changes in the pathways that occurs in the disease conditions. The urine and blood metabolome content in the normal and disease state is investigated based on the current metabolomics studies and well known metabolite candidate biomarkers for chronic kidney disease are discussed.
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Affiliation(s)
- Shiva Kalantari
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Number 103, Boostan 9th Street, Pasdaran Avenue, 1666663111 Tehran, Iran
| | - Mohsen Nafar
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Number 103, Boostan 9th Street, Pasdaran Avenue, 1666663111 Tehran, Iran
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Masakane I, Sakurai K. Current approaches to middle molecule removal: room for innovation. Nephrol Dial Transplant 2018; 33:iii12-iii21. [PMID: 30281129 PMCID: PMC6168896 DOI: 10.1093/ndt/gfy224] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/13/2018] [Indexed: 01/31/2023] Open
Abstract
Aggressive removal of middle molecules or larger low-molecular-weight proteins (LMWPs) has been a growing concern following studies on their harmful effects on the mortality and morbidity of chronic dialysis patients. To remove larger LMWPs and some protein-bound uremic toxins (PBUTs), high- and medium-cutoff (HCOs and MCOs, respectively) membranes, convective therapy and protein adsorptive membranes are available. When we use HCO or MCO membranes for convective therapy, we have to take care to avoid massive albumin leakage during a dialysis session. Convection volume is an important element to increase middle molecule removal; however, a larger convection volume has a risk of larger leakage of albumin. Predilution hemodiafiltration is a useful measurement to increase larger LMWPs without massive albumin leakage. β2-microglobulin (B2M), α1-microglobulin (A1M) and albumin leakage during a dialysis session are useful parameters for assessing middle-molecule removal. Reduction ratios of B2M >80% and of A1M >35% are favorable to improve severe dialysis-related symptoms. The efficacy of middle molecule removal should be evaluated in comparison with clinical outcomes, mortality, morbidity and the improvement of dialysis-related symptoms. Recently some dialysis-related symptoms such as sleep disturbance, skin itchiness and dialysis hypotension have been recognized as good surrogate makers for mortality. Further studies to evaluate the relationship between middle molecule or PBUTs removal and the improvement of patient symptoms should be performed in well-designed randomized controlled trials.
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Affiliation(s)
- Ikuto Masakane
- Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Kenji Sakurai
- Hashimoto Clinic, Dialysis Center, Sagamihara, Japan
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Gursu M, Uzun S, Topcuoğlu D, Koc LK, Yucel L, Sumnu A, Cebeci E, Ozkan O, Behlul A, Koc L, Ozturk S, Kazancioglu R. Skin disorders in peritoneal dialysis patients: An underdiagnosed subject. World J Nephrol 2016; 5:372-377. [PMID: 27458566 PMCID: PMC4936344 DOI: 10.5527/wjn.v5.i4.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/02/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit.
METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis.
RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.
CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.
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Coulibaly G, Korsaga-Somé N, Fomena DFY, Nagalo Y, Karambiri AR, Bassolet A, Kafando H, Traoré A, Lengani A. [Cutaneous manifestations in patients on chronic hemodialysis in a developing country]. Pan Afr Med J 2016; 24:110. [PMID: 27642449 PMCID: PMC5012827 DOI: 10.11604/pamj.2016.24.110.8639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Our study aims to highlight the most common skin disorders in patients on chronic hemodialysis at the University Hospital Yalgado Ouédraogo (CHU-YO) in Ouagadougou. The study, of transverse type descriptive, carried out of September 15 to December 31, 2014, is unrolled with the CHU-YO. This descriptive transversal study was conducted at the CHU-YO from September 15 to December 31, 2014. It involved patients who had been on chronic dialysis for at least 3 months. The frequency of hemodialysis sessions was one every five days. The significance level of statistical tests was defined as the probability p ≤ 0.05. Eighty-five patients (61.1% men and 38.9% women) with an average age of 42.1 years were included in the study. The mean duration of hemodialysis was 31.9 months. The success rate of biological examinations varied from 7,4 to 85,3%. Eighty patients (85,3%) had at least one cutaneous manifestation. Cutaneous xerosis (67.4%), pruritus (45.3%), and hyperpigmentation (23.2%) were the most frequent skin manifestations that may be specific of hemodialysis. Guttate hypomelanosis (11.6%), prurigo (11.6%) and folliculitis (8.4%) were the main non-specific skin manifestations. Skin involvement was frequent but did not seem related to seniority in hemodialysis. In Ouagadougou, bad hemodialysis conditions and a hot, dry environment promote such conditions, especially xerosis and pruritus. A better subvention of health care could help to reduce the prevalence of skin diseases and to improve the quality of life of our patients on chronic hemodialysis.
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Affiliation(s)
- Gérard Coulibaly
- Service de Néphrologie et Hémodialyse, Ouagadougou, Burkina Faso; Université de Ouagadougou, Burkina Faso
| | - Nina Korsaga-Somé
- Université de Ouagadougou, Burkina Faso; Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - Yacouba Nagalo
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - Alban Bassolet
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Hyacinthe Kafando
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Traoré
- Université de Ouagadougou, Burkina Faso; Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Lengani
- Service de Néphrologie et Hémodialyse, Ouagadougou, Burkina Faso; Université de Ouagadougou, Burkina Faso
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Moldovan D, Rusu C, Kacso IM, Potra A, Patiu IM, Gherman-Caprioara M. Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis. Med Pharm Rep 2016; 89:94-103. [PMID: 27004031 PMCID: PMC4777475 DOI: 10.15386/cjmed-515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM In spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients. METHODS This prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC). RESULTS All-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher death rates. Low dialysis efficacy represented a risk factor for mortality and CDV diseases and events. In PD patients, low albumin induced a higher death rate. In PD patients the death rate was similar to HD patients. CONCLUSION All-cause mortality was higher than in general population, but lower than the chronic dialysis patients' mortality reported in other studies. The death rates in HD and PD patients were similar. VC and serum P levels influenced the outcome in the HD patients - increased the risk for all-cause and CDV mortality, but also for CDV events. ALP levels influenced outcome in PD patients. There were no significant differences between HD and PD patients regarding outcome.
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Affiliation(s)
- Diana Moldovan
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Crina Rusu
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ina Maria Kacso
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Potra
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Mihai Patiu
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mirela Gherman-Caprioara
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Masmoudi A, Hajjaji Darouiche M, Ben Salah H, Ben Hmida M, Turki H. Cutaneous abnormalities in patients with end stage renal failure on chronic hemodialysis. A study of 458 patients. J Dermatol Case Rep 2014; 8:86-94. [PMID: 25621088 DOI: 10.3315/jdcr.2014.1182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/13/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cutaneous manifestations occurring in patients with end stage renal failure on hemodialysis are polymorphic and diverse. OBJECTIVE The aim of our study was to assess the prevalence and characteristics of different cutaneous manifestations in patients on hemodialysis. PATIENTS AND METHODS We led a transverse investigation of all patients on hemodialysis in 12 haemodialysis centres of Sfax (Tunisia). We examined 458 patients (254 men and 204 women). The hemodialysis history ranged from 6 months to 24 years. A total of 394/458 (86%) patients had cutaneous abnormalities. These included pruritus (56.6% of patients), paleness (60.7%), xerosis (52.8%), hyperpigmentation or hypopigmentation (38.4%), venous dilation near the fistula (22.2%), eczema in the fistula area (14.8%), half-and-half nails (13.5%), onychodystrophy (6.1%), subungual hemorrhage (4.5%), leukonychia (4.5%), stomatitis (5.6%), xerostomia (3.2%), gingivitis (2.4%), uremic breath (2.1%), and skin calcificatins (0.4%). Nephrogenic fibrosing dermopathy was not detected in any of our patients. CONCLUSIONS Pruritus, paleness, dry skin as well as hyperpigmentation and hypopigmentation are the most frequent skin abnormalities observed in hemodialysis patients. The early recognition of some cutaneous conditions associated with end stage renal failure and hemodialysis may allow early therapeutic intervention and decrease morbidity.
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Affiliation(s)
| | | | - Haifa Ben Salah
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, Sfax, Tunisia
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Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol 2014; 7:313-9. [PMID: 25419152 PMCID: PMC4235205 DOI: 10.2147/ccid.s70842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Patients and methods Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. Results This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Conclusion Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.
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Affiliation(s)
- Basma Mourad
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Doaa Hegab
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Kamal Okasha
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Cornelis T, van der Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, Leunissen KM, Kooman JP. Acute Hemodynamic Response and Uremic Toxin Removal in Conventional and Extended Hemodialysis and Hemodiafiltration: A Randomized Crossover Study. Am J Kidney Dis 2014; 64:247-56. [DOI: 10.1053/j.ajkd.2014.02.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/10/2014] [Indexed: 01/06/2023]
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Deshmukh SP, Sharma YK, Dash K, Chaudhari NC, Deo KS. Clinicoepidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis. Indian Dermatol Online J 2013; 4:18-21. [PMID: 23439945 PMCID: PMC3573445 DOI: 10.4103/2229-5178.105458] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Chronic renal failure (CRF) is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities. Aim: To evaluate the prevalence of various dermatoses in patients with CRF on hemodialysis and to study the effect of hemodialysis on the intensity of pruritus. Materials and Methods: A total of 35 patients of CRF on hemodialysis having at least one cutaneous manifestation were included in the study. Results: Twenty-four (68.71%) cases in our study belonged to the age group of 50-69 years, out of which 16 cases were in the sixth decade. Xerosis and pruritus occurred in 80% and 65.71% of cases, respectively. Other common findings included pallor (68.57%), dyspigmentation (34.29%), cutaneous infections (34.39%), acquired perforating dermatosis (17.4%), and nail changes (60%). Hemodialysis failed to improve pruritus in 17 (73.9%) of our patients. Twenty-six patients (74.28%) suffered from hypertension, 13 of them also were known cases of type II diabetes mellitus. Five patients suffered exclusively from type II diabetes mellitus. Conclusions: In our small study, xerosis was the commonest finding and pruritus, the commonest symptom. The intensity of pruritus was largely unaffected by hemodialysis.
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Affiliation(s)
- Supriya P Deshmukh
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, India
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Markova A, Lester J, Wang J, Robinson-Bostom L. Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial 2013; 25:408-18. [PMID: 22809004 DOI: 10.1111/j.1525-139x.2012.01109.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cutaneous abnormalities in patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal dialysis may demonstrate signs of their underlying condition or reveal associated disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is integral to establishing a diagnosis, certain conditions will resolve only with dialysis or improvement of their renal disease and others may not require or respond to treatment. Half and half nails, pruritus, xerosis, and cutaneous hyperpigmentation are common manifestations in ESRD. With hemodialysis, uremic frost is no longer prevalent in ESRD patients and ecchymoses have decreased in incidence. Acquired perforating dermatoses are seen in over one-tenth of hemodialysis patients. Metastatic calcinosis cutis and calciphylaxis are both rarely reported, although the latter is seen almost exclusively in the setting of hemodialysis. Diagnosis of nephrogenic systemic fibrosis has historically been challenging; as such, new diagnostic criteria have been proposed. Blood porphyrin profiles are needed to differentiate between porphyria cutanea tarda and pseudoporphyria. We will review and provide an update on the aforementioned common cutaneous manifestations of ESRD in patients receiving dialysis.
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Affiliation(s)
- Alina Markova
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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Duranton F, Cohen G, De Smet R, Rodriguez M, Jankowski J, Vanholder R, Argiles A. Normal and pathologic concentrations of uremic toxins. J Am Soc Nephrol 2012; 23:1258-70. [PMID: 22626821 DOI: 10.1681/asn.2011121175] [Citation(s) in RCA: 740] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An updated review of the existing knowledge regarding uremic toxins facilitates the design of experimental studies. We performed a literature search and found 621 articles about uremic toxicity published after a 2003 review of this topic. Eighty-seven records provided serum or blood measurements of one or more solutes in patients with CKD. These records described 32 previously known uremic toxins and 56 newly reported solutes. The articles most frequently reported concentrations of β2-microglobulin, indoxyl sulfate, homocysteine, uric acid, and parathyroid hormone. We found most solutes (59%) in only one report. Compared with previous results, more recent articles reported higher uremic concentrations of many solutes, including carboxymethyllysine, cystatin C, and parathyroid hormone. However, five solutes had uremic concentrations less than 10% of the originally reported values. Furthermore, the uremic concentrations of four solutes did not exceed their respective normal concentrations, although they had been previously described as uremic retention solutes. In summary, this review extends the classification of uremic retention solutes and their normal and uremic concentrations, and it should aid the design of experiments to study the biologic effects of these solutes in CKD.
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Maduell F, Arias M, Duran CE, Vera M, Fontsere N, Azqueta M, Rico N, Perez N, Sentis A, Elena M, Rodriguez N, Arcal C, Bergada E, Cases A, Bedini JL, Campistol JM. Nocturnal, every-other-day, online haemodiafiltration: an effective therapeutic alternative. Nephrol Dial Transplant 2011; 27:1619-31. [DOI: 10.1093/ndt/gfr491] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin cancer prevention education for kidney transplant recipients: a systematic evaluation of Internet sites. Prog Transplant 2011. [PMID: 21265287 DOI: 10.7182/prtr.20.4.9877500752888660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Repeated patient education about skin cancer prevention is important to self-care after transplant. OBJECTIVE Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. DESIGN Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. PARTICIPANTS An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. MAIN OUTCOME MEASURES Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination. CONCLUSION Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
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Affiliation(s)
- June K Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Ilinois, USA.
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Kocyigit I, Unal A, Tanriverdi F, Hayri Sipahioglu M, Tokgoz B, Oymak O, Utas C. Misdiagnosis of Addison's Disease in a Patient with End-Stage Renal Disease. Ren Fail 2011; 33:88-91. [DOI: 10.3109/0886022x.2010.528114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites. Prog Transplant 2010; 20:344-9. [DOI: 10.1177/152692481002000407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination Conclusion Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
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Affiliation(s)
- June K. Robinson
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Murad Alam
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Neda Ashourian
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Misbah Khan
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Roopal Kundu
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Anne E. Laumann
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | | | - Simon Yoo
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Elisa J. Gordon
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
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Shibata M, Nagai K, Usami K, Tawada H, Taniguchi S. The quantitative evaluation of online haemodiafiltration effect on skin hyperpigmentation. Nephrol Dial Transplant 2010; 26:988-92. [DOI: 10.1093/ndt/gfq479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sherman RA. Briefly Noted. Semin Dial 2010. [DOI: 10.1111/j.1525-139x.2009.00687.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hwang CY, Lin CS, Tseng ML, Liu HN. Spotted leucoderma after treatment of facial hyperpigmentation on hemodialysis patients employing 1064-nm Q-switched Nd:YAG laser. J COSMET LASER THER 2009; 12:47-50. [PMID: 19929290 DOI: 10.3109/14764170903352886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The development of skin hyperpigmentation in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been well documented. However, the cosmetic concern was neither valued seriously nor treated effectively in the past. We report a female case who suffered from facial hyperpigmentation (FH). She was treated by large-spot sized, 1064-nm Q-switched Nd:YAG laser (QSNYL). A significant improvement was found after three treatment sessions at a fluence of 3.9 J/cm(2) with 8-day intervals, but spotted leucoderma developed at the fourth visit. Neither residual FH nor spotted leucoderma subsequently improved following two additional sessions of 1064-nm QSNYL at a lower fluence with topical hydroquinone and HeNe laser, and it persisted at the 1-year follow-up. This clinically specific round-shaped leucoderma suggested laser-induced damage to melanocytes due to unsuitable application. The 1064-nm QSNYL with a large spot size and an appropriate parameter may become an effective therapeutic modality if properly utilized.
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Affiliation(s)
- Chian-Yaw Hwang
- Department of Dermatology, Taipei General Veterans Hospital, Taipei, Taiwan, Republic of China
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