Nephrology Book

Organ Failure

  • Renal Failure associated Pruritus

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Renal Failure associated Pruritus

Aka: Renal Failure associated Pruritus, Uremic Pruritus
  1. See Also
    1. Chronic Renal Failure
    2. Pruritus
  2. 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
  3. 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
  4. Symptoms
    1. Itch occurring in severe paroxysms
    2. Localized in 56% and generalized in 44% of patients
  5. 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
  6. References
    1. Ashmore (2000) Am J Kidney Dis 35(5):827-31 [PubMed]
    2. Gilchrest (1982) Arch Dermatol 118(3):154-6 [PubMed]
    3. Kam (1996) Anaesthesia 51:1133-38 [PubMed]
    4. Pauli-Magnus (2000) Clin Nephrol 11(3):514-9 [PubMed]
    5. Ponticelli (1992) Nephron 60:1-5 [PubMed]
    6. Schwartz (2000) Semin Dial 13(3):177-80 [PubMed]
    7. Szepietowski (1998) Int J Dermatol 37(4):247-53 [PubMed]

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