scholarly journals Cutaneous manifestations of end-stage renal disease

2020 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Navya Vanaja Sahadevan ◽  
Lissy Skaria ◽  
Kunjumani Sobhanakumari
Keyword(s):  
Calcium Phosphate ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Small Sample ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Treatment Comparison ◽  
Phosphate Product ◽  
Stage Renal Disease ◽  
End Stage

Objectives: (1) To study the dermatological manifestations in patients with end-stage renal disease (ESRD) of diverse etiology and (2) to compare the dermatological manifestations in patients on conservative treatment and those receiving hemodialysis. Materials and Methods: One hundred patients with ESRD who attended the nephrology/dermatology department of a tertiary care center were examined for dermatological manifestations. Results: All the 100 patients evaluated had at least one cutaneous manifestation. Pallor was the most common cutaneous finding in our study (64%). Xerosis was observed in 61% and pruritus in 46%. Other common findings included diffuse hyperpigmentation (22%) and cutaneous infections (20%). Specific changes noted were acquired perforating dermatoses (7%) and nephrogenic systemic fibrosis (2%). Nail, oral mucosa, and hair were affected in 61%, 54%, and 29% cases, respectively. No significant association was noted between dermatological manifestations and modality of treatment. Comparison of serum calcium, serum phosphorus, and calcium-phosphate product was done with pruritus and a significant association was noted between pruritus and the serum levels of phosphate and calcium-phosphate product. Limitations: Small sample size and the single center study design were the major limitations. Conclusion: Dermatological manifestations are common among patients with ESRD. Early diagnosis and prompt management of the dermatological diseases may improve the quality of life of the affected.

Clinical management of restless legs syndrome in end-stage renal disease patients

CNS Spectrums ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Zeyad T. Sahli ◽  
Jae Jo ◽  
Shaker A. Mousa ◽  
Frank I. Tarazi
Keyword(s):  
Renal Disease ◽  
Restless Legs Syndrome ◽  
End Stage Renal Disease ◽  
Treatment Guidelines ◽  
Small Sample ◽  
Limited Information ◽  
Restless Legs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Restless legs syndrome (RLS) is a common neurological movement disorder, characterized by restless and unpleasant sensations in the deep inside of legs. The symptoms of RLS are less noticeable during daytime, but more prevalent at night. Therefore, the disorder can induce low quality of life, insomnia, and impairment of daytime activity. RLS in end-stage renal disease (ESRD) patients is especially problematic due to premature discontinuation of dialysis and increased mortality. The prevalence of RLS among dialysis patients is much higher compared to the prevalence of the same disorder in patients with normal renal functions. Even though there are recommended treatment guidelines for the general population established by Medical Advisory Board of the RLS foundation, which include the use of dopamine agonists, levodopa, gabapentin, benzodiazepines, and opioids, limited information is available on the effects of these therapies in ESRD patients. Since the existing clinical data were extrapolated from small sample sizes in short-term clinical trials, further clinical studies are still needed to better assess the efficacy, safety, and tolerability of these medications in patients with ESRD.

scholarly journals CUTANEOUS MANIFESTATIONS IN PATIENTS UNDERGOING HAEMODIALYSIS FOR END STAGE RENAL DISEASE

2015 ◽  
Vol 4 (34) ◽  
pp. 5872-5876 ◽  
Author(s):  
Gupta Uphar ◽  
Raghavendra Prasad B N ◽  
Vidyasagar C R ◽  
Vaishnavi Alam ◽  
Harish B V
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cutaneous Manifestations ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Antineutrophil Cytoplasmic Autoantibody—Associated Glomerulonephritis in Children

2001 ◽  
Vol 12 (7) ◽  
pp. 1493-1500 ◽  
Author(s):  
MOTOSHI HATTORI ◽  
HIDEAKI KURAYAMA ◽  
YASUSHI KOITABASHI
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Crescentic Glomerulonephritis ◽  
Small Sample ◽  
Renal Outcome ◽  
Necrotizing Crescentic Glomerulonephritis ◽  
Antineutrophil Cytoplasmic Autoantibody ◽  
Stage Renal Disease ◽  
End Stage

Abstract. A retrospective investigation was conducted by members of the Japanese Society for Pediatric Nephrology from 1990 to 1997 to define the clinical features and outcome of antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis in children. Thirty-four ANCA-seropositive Japanese pediatric patients with biopsy-proven pauci-immune necrotizing crescentic glomerulonephritis were identified. Of these, 3 cases associated with Wegener's granulomatosis were excluded because of the small sample size. Among the 31 patients studied, 10 had a diagnosis of necrotizing crescentic glomerulonephritis alone and 21 had microscopic polyangiitis. Females predominated (87%), and the median age at onset was 12 yr. Twenty-six patients received treatment with cyclophosphamide and corticosteroids, and five patients received treatment with corticosteroids alone; 84% of patients achieved remission, and 39% of responders relapsed in a median of 24 mo. ANCA titers correlated with response to treatment and disease activity, with some exceptions. Patients were followed for a median of 42 mo (range, 3 to 96 mo). Nine of 31 patients (29.0%) progressed to end-stage renal disease, 6 (19.4%) had reduced renal function, and 15 (48.4%) had normal renal function at the last observation. One patient (3.2%) died from cytomegalovirus infection 3 mo after initiation of therapy. Life-table analysis showed 75% renal survival at 39 mo. Patients who subsequently developed end-stage renal disease (n= 9) had significantly higher average peak serum creatinine levels and more chronic pathologic lesions at diagnosis compared with patients with favorable renal outcome (n= 15). In conclusion, our clinical experience suggests that the clinical disease spectrum of ANCA-associated glomerulonephritis is similar in pediatric and adult patients, but there is a female predominance in children.

scholarly journals Incidence of cutaneous manifestation in patients with end stage renal disease

2017 ◽  
Vol 4 (4) ◽  
pp. 989
Author(s):  
Khileshwar Singh ◽  
Amit Thakur ◽  
Kamlesh Dhruv
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cutaneous Manifestation ◽  
Renal Diseases ◽  
Cutaneous Manifestations ◽  
Stage Renal Disease ◽  
End Stage

Background: Kidney failure as well as renal diseases is the most important health problems affecting the middle and old age population all over the world. They were supposed to be fatal till recently. The objective of this study was to study incidence of cutaneous manifestation in patients with end stage renal disease.Methods: A hospital based cross sectional study was carried out from July 2012 to June 2013 in the Department of General Medicine, Late Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh, India. It was possible to study a total of 50 cases of cutaneous manifestations that are already known cases of end stage renal disease. All patients with skin lesion were evaluated by history, clinical examination (systemic and dermatological), biopsy and other relevant investigations procedure for skin disease during the course of current renal disease and their stay in the hospital.Results: The incidence of cutaneous manifestations among patients with acute renal failure was zero. It was 86% among patients with chronic renal failure. The most common manifestation was pruritus in 14% of cases followed by oral candidiasis in 4% of cases. Next common was scabies in 6% of cases and this was followed by herpes zoster and Tinea cruris in 4% of cases each. Folliculitis was seen in only one case. It was seen that all types of cutaneous manifestations were present only in patients with chronic renal failure, whereas patients of acute renal failure did not show any sort of cutaneous manifestations.Conclusions: Chronic renal failure was observed as the important cause of cutaneous manifestations seen in patients with end stage renal disease. No cases were seen in patients with acute renal failure. Thus, it is important that patients with acute renal failure take proper precautions to avoid cutaneous manifestations up to the extent possible.

scholarly journals Parathyroid Hormone Status in Patients with End Stage Renal Disease on Maintenance Haemodialysis

2014 ◽  
Vol 4 (1) ◽  
pp. 13-17
Author(s):  
SM Sajjad ◽  
YA Zaman ◽  
MA Rahim ◽  
A Mahmuda ◽  
WMM Haque ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Calcium Phosphate ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Haemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Pth Level

Objective: To evaluate parathyroid hormone (PTH) status among end stage renal disease (ESRD) patients on maintenance haemodialysis (MHD). Methodology: This descriptive cross-sectional study was done in the Department of Nephrology, BIRDEM General Hospital, Dhaka, from April to September 2011. Results: A total of 50 patients were included in this study with a 3:2 male predominance. Mean age was 54.6 (range 34-76) years. Mean duration of ESRD was 3.73 years. All the patients were diabetic and other common co-morbidities were hypertension (76%), dyslipidaemia (56%), ischaemic heart disease (48%) and stroke (12%). They were receiving calcium (72%), vitamin D (40%), both calcium and vitamin D (38%) supplementation and 20% were not on any medication for treatment of chronic kidney disease mineral bone disorder (CKD-MBD). Mean pre-dialysis values of urea and creatinine were 30.28 mg/dl and 8.67 mg/dl respectively. Mean (± SD) serum level of calcium, phosphate and PTH were 8.32 (±1.26) mg/dl, 4.42 (±1.54) mg/dl and 125.45±117.71 pg/ml respectively. In 76% of the study subjects, PTH level was above normal. Significant difference (P=<0.05) in PTH levels was observed among patients with and without any medication for prevention of CKD-MBD but the levels were within the acceptable range. Serum calcium level in the study subjects had significant positive relationship with serum PTH level. It was also observed that PTH level had significant negative relationship with phosphate level. Conclusion: PTH level was higher in ESRD patients on MHD specially those who were not on any medication than those who took calcium, vitamin D or both but it was still within the acceptable reference range. In such patients, serum calcium, phosphate and PTH levels should be monitored periodically. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18547 Birdem Med J 2014; 4(1): 13-17

scholarly journals Estimation of Serum Vitamin D2, Growth Hormone, Alkaline Phosphatase and Calcium Phosphate Product in Patients with End Stage Renal Disease

2021 ◽  
Vol 9 (01) ◽  
pp. 61-65
Author(s):  
Santosh Chaudhary ◽  
Narayan Gautam ◽  
Manoj Karki ◽  
Sunkeshari Deshar ◽  
Archana Jayan ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
End Stage Renal Disease ◽  
Hypovitaminosis D ◽  
Vitamin D2 ◽  
Hypertension Status ◽  
Significant Difference ◽  
Phosphate Product ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

INTRODUCTION The chronic kidney disease (CKD) patient's calcium phosphate product, alkaline phosphatase (ALP), vitamin-D2  and human growth hormone (hGH) are altered under haemodialysis. This study aimed to evaluate these biochemical variables in conjunction with haemoglobin and blood pressure to find out their association in End Stage Renal Disease (ESRD) patients. MATERIAL AND METHODS This cross-sectional study comprised of 104 patients with ESRD undergoing haemodialysis. The estimated glomerular filtration rate (eGFR) was calculated by Cockcroft-Gault (CG) equation and calcium, phosphorus, ALP were measured by fully automated analyzer whereas vitamin-D2  and hGH were measured by sandwich and competitive enzyme linked immune sorbent assay (ELISA) techniques. RESULTS The mean age of patients was 53.12 ±16.37 years comprising 68% male. The hypovitaminosis D was 57.7% deficiency and 23.1% insufficiency states whereas hGH insufficiency was 22.1%. The calcium phosphate product was found to be increased in only 39.9% cases. The increased ALP level was observed in 64.4% cases. There was statistically significant association between hGH and Hb status (p=0.03). The significant difference in mean sodium and Ca×P of ESRD cases was observed with hypertension status (p=0.03 and p=0.01) respectively. Moreover, the significant difference in mean eGFR and hGH was observed with haemoglobin status (p=0.0001and p=0.01) respectively. CONCLUSION Increased level of ALP and hypovitaminosis-D was very common in ESRD patients undergoing dialysis with less prevalence of hGH insufficiency and calcium phosphate product increment. The anaemia and hypertension status can be pre-existing condition with ESRD which are cumbersome to control if not monitor in these patients.

Cutaneous manifestations of end-stage renal disease

2015 ◽  
Author(s):  
Timur A. Galperin ◽  
Kieron S. Leslie ◽  
Antonia J. Cronin
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Skin Diseases ◽  
Treatment Options ◽  
Electrolyte Imbalance ◽  
Cutaneous Manifestations ◽  
Metastatic Calcification ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

A broad range of skin diseases occur in patients with end-stage renal disease. Some of these conditions are benign, and make little impact on patients’ lives. Others, however, have a greater impact on quality of life, may be physically disabling, and even life-threatening. Mostly, they result from a combination of factors, such as electrolyte imbalance and co-morbid disease. Uraemic pruritus is the most commonly troublesome and an approach to it is presented. Other non-specific skin manifestations of CKD include skin-colour changes, xerosis, half-and-half nails Specific manifestations include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. Pathophysiology, clinical presentation, diagnosis, and treatment options are discussed.

scholarly journals MON-368 A Case of Uremic Tumoral Calcinosis with Secondary Hyperparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Justin Mathew ◽  
Preeti Kishore
Keyword(s):  
Calcium Phosphate ◽  
Soft Tissue ◽  
Secondary Hyperparathyroidism ◽  
End Stage Renal Disease ◽  
Tumoral Calcinosis ◽  
Intact Pth ◽  
Phosphate Product ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Uremic tumoral calcinosis is an uncommon clinical entity that can be seen in patients with end-stage renal disease, characterized by development of calcific deposits in the soft tissue. This condition can cause significant pain and impairment of mobility for patients. While it appears that elevation in calcium-phosphate product and hyperparathyroidism may each play a role in the development of these deposits, these conditions are neither necessary nor sufficient for this process to occur. As a result, the optimal treatment of this condition is not well-established. Case: A 50-year-old man with history of ESRD since 2015 secondary to autosomal dominant polycystic kidney disease on peritoneal dialysis, HTN, and secondary hyperparathyroidism presented to the emergency room with progressive right lateral hip pain, reaching the point where the patient could no longer ambulate. Exam demonstrated a thin man whose right hip was tender to palpation with limited range of motion, as well as a palpable, deep right upper leg mass. Laboratory findings were significant for a creatinine of 14.83mg/dL (n &lt;1.5mg/dL), calcium of 9.1 mg/dL (n 8.5-10.5mg/dL), phosphate of 7.9mg/dL (n 2.5-4.5mg/dL), intact PTH of 1129pg/mL (n 15-65pg/mL), and 25-OH Vit D of 20.4ng/mL (n&gt;30ng/mL). X-ray of the right femur demonstrated a 9cm calcified soft tissue lesion, which was not present on imaging 7 months earlier. Subsequent CT of the pelvis showed a cystic, multilobulated calcified mass in the right gluteus, measuring 6.1 x 3.5 x 7.5cm, consistent with tumoral calcinosis. Attempts to normalize his serum phosphorous level using treatment with phosphate binders or changes to his dialysate had failed previously, and the patient declined transitioning to hemodialysis. Nuclear medicine parathyroid scan demonstrated four-gland hyperplasia, and the decision was made to perform 3.5 gland parathyroidectomy. Two days post-operatively calcium had dropped to 7.7 mg/dL, phosphate to 6.8mg/dL, and intact PTH to 29pg/mL. Conclusions: Uremic tumoral calcinosis is a very rare but potentially debilitating consequence of end-stage renal disease that can be significantly detrimental to quality of life in patients with ESRD. Elevated calcium-phosphate product is frequently implicated in its development, and evidence exists that lowering these levels can lead to complete resolution of these lesions. However, in patients for whom medical therapy is not effective and who have concomitant secondary hyperparathyroidism, subtotal parathyroidectomy is a reasonable treatment option.

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