Introduction:
Kidney failures can be long-standing and require long-term treatment. Over the course of treatment, a patient can develop various skin conditions. These are not expressed prior to identifying the underlying kidney disorder but rather often as a result of treatment such as hemodialysis. These require proper monitoring and follow-up to prevent further infection.
What Are the Common Skin Manifestations of Renal Diseases?
1) Xerosis:
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Dry skin or xerosis is a common skin manifestation of chronic renal disorders. Dry skin is prevalent in patients with an end-stage kidney disorder requiring dialysis or a kidney transplant. It has been reported in 50 to 80% of patients on dialysis.
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It is found on the legs, forearms, and thigh extensor surfaces.
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Skin becomes rough, scaly, tight, and cracks easily. It develops fish-like scales.
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Reduction in the size of sweat glands or degeneration of sebaceous glands is the cause of this condition.
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The condition is managed by using topical moisturizers and emollients to damp skin; the patients are advised not to shower excessively as the condition can be worsened by soap accumulation. A moisturizer containing 10% urea can also be beneficial.
2) Nephrogenic Systemic Fibrosis:
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NSF is a systemic fibrotic disorder that is rare but found commonly associated with renal diseases. The skin becomes fibrosed; that is, skin is hardened, thickened, and pigmented with or without shiny changes.
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Fibrotic skin around joints causes difficulty in joint movements.
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It is commonly found in areas such as ankles, feet, thighs, fingers, lower arms, and hands.
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NSF is believed to be a result of increased collagen deposition, which can affect multiple organ systems such as the heart, lungs, and liver.
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There is no definitive curative treatment for the condition; systemic or topical corticosteroids, thalidomide, plasmapheresis, Imatinib mesylate, immunoglobulin infusion, and Rapamycin have shown to produce some improvement.
3) Access Site Infections:
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Hemodialysis requires an access site, but these sites are prone to infections. These infections can be one of the leading causes of death in these patients, second only to coronary artery disease.
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In addition, access points for blood vessels can be a gateway for bacteremia in hemodialysis patients. The risk of infections is highest in catheters, followed by grafts and native vessel fistulas. The decreased immunity and diminished neutrophil function, leukopenia, and complement activation are factors that promote infections.
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Access site infections can be prevented by observing proper sterile conditions, such as the use of clean gloves during needle cannulation and strict hand washing. Patients should also observe practices that reduce bacterial infection, thereby preventing the introduction of infection into the bloodstream. High fever and elevated white blood count should alert health experts about access site infection. Extensive evaluation, in addition to complete blood count and blood cultures, must be done too if any new lesion, inflammation, or induration is seen at the access sites.
4) Acquired Perforating Dermatosis:
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APD, or acquired perforating dermatosis, is a group of disorders with loss of elastic tissue, transepidermal elimination, or necrotic tissue in adulthood.
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Kidney failure or diabetes mellitus can be the underlying cause of this, along with dialysis. It is characterized by increased keratinized discolored lesions (hyperkeratotic papular lesions). About 4 to 10% of chronic renal patients with hemodialysis have APD. It is found on the trunk and extensor surface of limbs.
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It is believed to be a decay or differentiation anomaly of the connective tissue in the dermis. Frequent scratching can cause secondary trauma and necrosis to the dermis. The skin condition resolves without treatment; if necessary, topical and intradermal steroids, topical retinoids, and UVB light have been found to have some benefits.
5) Non-melanoma Skin Cancer:
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The most commonly found malignancy in renal transplant patients is non-melanoma skin cancer. There are 20 times more chances for a renal transplant patient to develop NMSC than the general population.
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The increased incidence of it is believed to be due to immunosuppression.
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Squamous cell carcinoma and basal cell carcinoma are the two common types of non-melanoma skin cancer, of which SCC is more aggressive and found commonly in recipients of renal transplants. Older age (greater than 55 years), duration of immunosuppression, dosage, and history of skin cancer prior to transplantation increases the risk of development of NMSC along with white skin and male gender.
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Patients at increased risk must be regularly monitored by the clinicians and also made aware of the situation. They must be taught to perform a self-examination. Lesions are localized to the head and face and may require surgical intervention. There should be regular follow-up appointments.
6) Itchy Skin:
Extremely itchy skin can be a common symptom of advanced kidney disease. It can be in one area of the skin or spread across the skin.
7) Color Changes to Skin:
Toxins build up in the skin when effective filtration and excretion are impaired by faulty kidney function. These toxins can cause a change in skin color. It can be a
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Pale color.
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Gray hue.
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Yellowish color.
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Cysts that resemble white heads.
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Yellowish thick skin.
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Darkened skin.
8) Scratch Marks:
Itching can lead to scratch marks which can become bleeding sores, nodularis prurigo (itchy bumps), and lichen simplex chronicus (thick leathery skin). UVB therapy can provide some relief.
9) Nail Changes:
Kidney disease can change the appearance of fingernails and toenails. Half-and-half nails, white color on the upper part of more than one nail to a reddish brown color below. White bands across nails are called Muehrcke’s nails. Pale nails.
10) Lump In Belly:
It can be a sign of kidney cancer; however, it can be asymptomatic in the early stages. As cancer advances, a mass can form on the belly, side, or lower back.
11) Blisters:
Patients with end-stage kidney disorders can develop blisters on the face, feet, and hands.
12) Skin Tightness:
This occurs when a contrasting agent is injected into the body for an investigation, like MRI. Skin can become hard and tight to pinch; elbow and knee mobility is also affected. Gadolinium in the contrasting agent can affect the kidneys; this is the reason for the skin manifestation.
13) Rash:
Faulty kidney function can result in improper removal of waste from the body, which can, in turn, result in the development of rashes. The rashes can be dome-shaped, itchy, and small; small bumps can join together to form raised, rough patches.
14) Swelling:
The kidney is responsible for filtration; if excess fluids are not removed by the kidney, it can cause swelling in the ankles, legs, feet, hands, and face.
15) Calcium Deposition:
Balancing electrolytes function may be affected in kidney failure; in such cases, deposits of calcium can be found in the skin, joints, and fingertips. A chalky discharge can be observed if these deposits push up through the skin.
Conclusion:
Renal disorders can exhibit cutaneous manifestations. As the life expectancy of patients with renal disorders improves, dermal problems are more likely to be expressed. Skin conditions are not a sign of kidney disorders but rather a secondary manifestation of them. It resolves by treating kidney disease. Topical steroids and retinoids can be helpful. The patient may need regular monitoring and follow-up.
