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STUDIES
Year : 1992  |  Volume : 58  |  Issue : 5  |  Page : 320-322

Cutaneous changes in chronic renal failure




Correspondence Address:
Gurcharan Singh


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  Abstract 

Clinical and histological skin changes were studied in 30 cases of chronic renal failure. Generalised pruritus and numbness were the commonest symptoms observed in 14 and 11 patients respectively. Ichthyotic skin changes of varying degree were observed in 27 cases and hyperpigmentation of sun-exposed skin was seen in 11 cases. Half and half nails were seen in 4 cases only. Cutaneous changes like pruritus, pallor, scaling and hair loss correlated strongly with the severity of renal failure. Histopathological examination revealed epidermal and dermal changes, latter were seen only in moderate to severe cases of renal failure.


Keywords: Chronic renal failure


How to cite this article:
Singh G, Verma A K, Singh G, Singh S J. Cutaneous changes in chronic renal failure. Indian J Dermatol Venereol Leprol 1992;58:320-2

How to cite this URL:
Singh G, Verma A K, Singh G, Singh S J. Cutaneous changes in chronic renal failure. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Feb 29];58:320-2. Available from: http://www.ijdvl.com/text.asp?1992/58/5/320/3836



  Introduction Top


Chronic renal failure (CRF) is associated with a variety of nonspecific clinical and histological changes in skin, regardless of its aetiology. Primary disease process leading to CRF and various treatment modalities like drugs, dialysis, and renal transplantation can also produce skin lesions in patients of renal insufficiency. [1],[2]

There are remarkably few studies on cutaneous manifestations of CRF. [3] Here we report our observations on cutaneous changes in 30 patients of CRF.


  Material and Methods Top


Thirty cases of CRF were evaluated. A detailed history was taken and complete clinical examination was carried out in all cases. Relevant haematological investigations were carried out and skin biopsy was performed in all cases from apparently normal looking skin over the back. All patients were taken up for study before commencement of dialysis and none of the patients had undergone renal transplantation. Severity of CRF was assessed by calculating creatinine clearance and graded as follows

Mild CRF - Creatinine clearance more than 30 ml/minute

Moderate CRF - Creatinine clearance 10-30 ml/minute

Severe CRF - Creatinine clearance less than 10 ml/minute

Nineteen men and 11 women in age range 14-67 years were included in the present study. Majority of the patients (17) were in their 3rd and 4th decades of life. Duration of CRF after diagnosis varied from 3 month to 2 years.


  Results Top


Generalised pruritus was the commonest symptom observed in 14 patients. Numbness/tingling and poor wound healing were recorded in 2 patients, both of them having diabetes mellitus as the underlying pathology. Two patients complained of easy bruising and recurrent bacterial infections. lchthyotic skin changes of varying degree were observed in 27 patients. Hyperpigmentation of skin more marked in sun-exposed parts of body was seen in 11 patients. Sparse body/scalp hair and purpuric skin lesions were noticed in 6 and 2 patients respectively. None of the patients had features of calcinosis cutis or uraemic frost. Nail examination revealed pallor in most of the cases. Half and half nails were seen in 4 patients. Dystrophic nail changes were observed in 6 cases. Clubbing and Beau's lines were noticed in 3 and 2 patients respectively.

An attempt was made to correlate cutaneous sign and symptoms with the severity of renal failure [Table - 1]. Pruritus, pallor, and scaling were seen predominantly in moderate and severe cases of CRF. Manifestations like hair loss, and half and half nails were observed in moderate to severe cases only.

Histological examination of skin revealed epidermal changes like hyperkeratosis, thinning of prickle cell layer, flattening of rete ridges, and pigment accentuation in basal cell layer, which did not correlate well with the severity of CRF. Dermal changes were seen in moderate to severe cases only and comprised of endothelial prominence of superficial blood vessels, sparse appendages, hyalinisation of collagen, and round cell infiltration in upper dermis [Table - 2].


  Comments Top


Generalised pruritus recorded in 47% of patients in our study is reported to be the most common cutaneous symptom in CRF, with a prevalence of 15%-49% in renal disease. [4] Diffuse hyperpigmentation accentuated in sun-exposed areas, seen in 36% of our patients is characteristic of uraemic patients. [5]

The half and half nail which had been emphasized as a marker of uraemia consists of proximal white band and distal red brown band occupying 20% to 60% of nail plate. These have been reported in 20% to 35% of patients with CRF, as compared with 2% of the general hospital population. [6] This findings was seen in 13% of patients in our study.

Histopathologic changes in skin consistent with our findings have been described in renal failure. [7] An association between uraemia and cutaneous microangiopathy has also been reported. [5]



 
  References Top

1.Gupta AK, Gupta MA, Cardella CJ, Haberman HJ. Cutaneous associations of chronic renal failure and dialysis. Int J Dermatol 1986; 7: 498-504.  Back to cited text no. 1    
2.KlintA, Bussels L, Fernandes M, et al. Skin and nail disorders in relation to chronic renal failure. Acta Dermato Verereol 1974; 54: 137-40.  Back to cited text no. 2    
3.Singh G, Singh SJ, Chakrabafty N, et al. Cutaneous manifestations of chronic renal failure. Ind J Dermatol Venereol Leprol 1989; 55: 167-9.  Back to cited text no. 3    
4.Chargin L, Keil K. Skin disease in non-surgical renal disease. Arch Dermatol Syphilol 1931; 26: 313-34.  Back to cited text no. 4    
5.Gilcherest BA, Rowe JW, Mihm MC Jr. Clinical and histological skin changes in chronic renal failure. Evidence for a dialysis resistent, transplant responsive microan giopathy. Lancet 1980; 2: 1271-5.  Back to cited text no. 5    
6.Lindsay PG. The half and half nail. Arch Int Med 1967; 119: 583-7.  Back to cited text no. 6  [PUBMED]  
7.Rowe JW, Gilcherest BA. Cutaneous aspects of renal disease. In Dermatology in General Medicine (Fitzpatrick TB, Eisen AZ, Wolff K, et al, eds), 3rdedn. New York: McGraw Hill, 1979; 1408-11.  Back to cited text no. 7    


    Tables

[Table - 1], [Table - 2]



 

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