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Renal Failure associated PruritusAka: Uremic Pruritus

See Also
1. Chronic Renal Failure
2. Pruritus
Epidemiology of Pruritus in Chronic Renal Failure
1. Pruritus affects 86% of Hemodialysis patients
2. Affects 25% of non-dialysis Renal Failure patients
3. Provocative
  1. Worse in summer
  2. Variable association with dialysis timing
Pathophysiology: Proposed mechanisms
1. Secondary Hyperparathyroidism and Hypercalcemia
2. Hyperphosphatemia
3. Aluminum overload
4. Mast cell proliferation
5. Plasma histamine level increases
6. Sebaceous Gland atrophy
7. Eccrine Sweat Gland atrophy
8. Microangiopathy
Symptoms
1. Itch occurring in severe paroxysms
2. Localized in 56% and generalized in 44% of patients
Management
1. Ultraviolet (UV) Light Therapy
  1. Ultraviolet B
  2. Ultraviolet A with Psoralen (PUVA)
2. Polidocanol (balneotherapy)
3. Activated Charcoal 6 grams per day
4. Topical Capsaicin 0.0255%
5. Cimetidine
6. Cholestyramine
7. Ineffective therapies
  1. Poor response to Antihistamines
  2. No relief with Naltrexone
  3. No relief with Ondansetron
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.