Psoriasis and Kidney Disease - An Overview

Introduction:

Psoriasis is a chronic inflammatory disease associated with cardiovascular and metabolic comorbidities, especially in younger and more severely ill patients. Recent cases have emerged showing a link between psoriasis and kidney disease. Kidney malfunctioning is directly related to an increased risk of cardiovascular disease, and it is susceptible to the toxic effects of some of the traditional drugs used to combat psoriasis.

What Is Psoriasis-Induced Kidney Disease?

Psoriasis is a recurrent, chronic inflammatory skin disease that affects 0.1% to 2.9% of the population worldwide. Psoriasis can also present with other manifestations. Associations have been observed between psoriasis and many other diseases, including diabetes mellitus, obesity, heart disease, hypertension, Crohn's disease, cancer, and depression. Due to the inflammatory nature of psoriasis, kidney disease develops more frequently in patients with more extensive skin lesions. Severe psoriasis is associated with the use of nephrotoxic drugs such as NSAIDs and immunosuppressants, as well as other classic factors such as age and gender. Psoriasis increases the risk of cardiovascular disease.

What Are the Causes of Psoriasis-Induced Kidney Disease?

The development of kidney disease in psoriasis is directly related to prevalent risk factors in psoriasis patients, including hypertension, diabetes, obesity, dyslipidemia, and metabolic syndrome, all of which are independent cardiovascular risk factors. Chronic kidney disease is defined as reduced renal function, expressed by a glomerular filtration rate (GFR) < 60 milliliters per minute per 1.73-meter square or renal impairment for at least three months. or the presence of proteinuria or hematuria.

There are various causes of kidney disease in people with psoriasis:

1. Malfunctioning of kidneys is directly related to cardiovascular disease, and psoriasis is known to be prevalent in people with cardiovascular diseases.

2. Autoimmune diseases can lead to glomerular injury.

3. Some of the drugs used to combat psoriasis are nephrotoxic.

What Are the Risk Factors of Psoriasis-Induced Kidney Disease?

The risk factors of psoriasis-induced kidney disease are:

• Infections, such as sore throats and skin infections.

• Weather, especially cold and dry conditions.

• Skin injuries, including cuts, scrapes, insect bites, and severe sunburn.

• Smoking and exposure to secondhand smoke.

• Heavy alcohol consumption.

• Certain drugs such as lithium, antihypertensive drugs, antimalarial drugs, etc.

• Rapid discontinuation of oral or injected corticosteroids.

• This condition occurs within families. Having a parent with psoriasis increases the risk of developing the disease. Also, having a parent with psoriasis increases the risk even more.

What Are the Symptoms of Psoriasis-Induced Kidney Disease?

The signs & symptoms of damage to the kidney due to the drugs include:

• Shortness of breath.

• Excessive fatigue.

• Nausea.

• Chest pain or pressure.

• The fluid buildup causes swelling in the legs, ankles, and feet.

• Decreased urine output.

• Irregular heartbeat.

What Are the Possible Complications of Psoriasis-Induced Kidney Disease?

Chronic kidney disease can affect almost any body part. Possible complications are:

• Fluid retention causes swelling of the arms or legs, high blood pressure, or fluid accumulation in the lungs (pulmonary edema).

• A rapid increase in potassium levels in the blood (hyperkalemia) can affect the heart and be life-threatening.

• Anemia.

• Heart disease.

• Weakened bones and increased risk of fractures.

• Decreased libido, erectile dysfunction, or decreased fertility.

• Central nervous system damage can cause difficulty concentrating, personality changes, or seizures.

• Decreased immune response and increased susceptibility to infections.

• Pericarditis is an inflammation of the sac-like membrane surrounding the heart (pericardium).

• Pregnancy complications that pose risks to mother and fetal development.

• Irreversible kidney damage (end-stage renal disease), eventually necessitating dialysis or a kidney transplant for survival.

When to Get Help for Psoriasis-Induced Kidney Disease?

The doctor should be informed if signs or symptoms of kidney disease are noticed. Early detection can prevent kidney disease from progressing into kidney failure. In addition, urine and blood tests may be done to monitor blood pressure and kidney function during a doctor's visit if people have conditions that increase the risk of kidney disease. Ask the doctor if these tests are necessary.

How Is Psoriasis-Induced Kidney Disease Diagnosed?

Blood and urine tests are done to diagnose kidney disease. The following parameters are checked in these tests:

• Serum Creatinine Levels - A creatinine test measures how well the kidneys filter waste products from the blood. Creatinine is a chemical compound left over from energy-producing processes in muscles. Healthy kidneys filter creatinine from the blood. Creatinine leaves the body as a waste product in the urine.

• Measurement of Blood Urea Nitrogen (BUN) - This test measures the amount of urea nitrogen present in the blood. Urea nitrogen is a waste product filtered from the blood by the kidneys.

• Creatinine Clearance - Creatinine clearance is usually determined from creatinine measurements in 24-hour urine samples and serum samples taken over the same period.

• Glomerular Filtration Rate - The kidneys have small filters called glomeruli. These filters help remove waste and excess water from your blood. The GFR test estimates the amount of blood that passes through these filters in one minute.

How Is Psoriasis-Induced Kidney Disease Treated?

Chronic kidney disease is incurable, but treatment can relieve symptoms and prevent them from worsening. However, treatment depends on the stage of chronic kidney disease.

The main treatments are:

• Lifestyle Changes - Helps keep a healthy state of mind and body.

• Medications - To control kidney-related problems such as high blood pressure and cholesterol.

• Dialysis - Mimics some kidney functions that may be required in advanced-stage kidney disease.

• Kidney Transplant - This may also be required for advanced (stage 5) CKD.

How to Prevent Psoriasis-Induced Kidney Disease?

The prevention of psoriasis-induced kidney disease is done by keeping the following points in check:

• Baseline renal function should be assessed, and the patient's renal function should be considered when prescribing new drugs.

• Dosage adjustments should be made based on the patient's underlying renal function.

• Risk factors for nephrotoxicity must be corrected before treatment starts.

• Concomitant nephrotoxic drugs (drugs that can potentially damage the kidney) should be avoided.

• Drink plenty of fluids before and during treatment.

• Effective non-nephrotoxic should be used whenever possible.

Conclusion:

Psoriasis is a systemic inflammatory disease that can increase the risk of comorbidities such as hypertension, dyslipidemia, and diabetes. People with severe forms of psoriasis are at increased risk of kidney disease. Psoriasis increases the risk of mesangial proliferative glomerulonephritis (increased number of mesangial cells in the kidneys). The increased prevalence of renal injury in psoriasis may result from vascular injury caused by inflammation and other comorbidities. Some drugs used to treat psoriasis are nephrotoxic with long-term use. Patients with moderate-to-severe psoriasis or psoriatic arthritis should be routinely monitored for renal function by measuring the glomerular filtration rate.