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Renal Failure associated Pruritus

Aka: Renal Failure associated Pruritus, 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

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/17/2012.

This is one of 5740 pages in the Family Practice Notebook