Dermatological Manifestations in Patients with Chronic Renal Failurea: A Clinicopathological Study

The skin is not an inert covering but a sensitive dynamic boundary. In addition to disorders that primarily affect the skin, most of the major systemic diseases have cutaneous manifestations (1). Skin is the most visible and easily accessible organ of the body. It is a mirror for many systemic diseases including renal diseases (2). The protean cutaneous manifestations of renal disease are primarily encountered in patients with chronic renal failure (CRF) (3). About 50-100% of patients with end stage renal disease (ESRD) have at least one associated cutaneous change (4,). These cutaneous disorders can precede or follow the initiation of hemodialysis treatment and there are more chances of developing newer skin changes during the course of hemodialysis therapy (5). Some of these cutaneous disorders disappear following kidney transplantation, confirming that the metabolic milieu resulting from the malfunctioning kidney is responsible for some of these changes. Other lesions may be related to the cause of CRF (6). The present study was planned to evaluate the spectrum of clinical profile and histopathological changes in the skin of CRF patients and to elucidate their association with the severity of disease process. Material and Methods This study was done on one hundred diagnosed cases of CRF taken from the outpatient department, medical wards and dialysis ward of the department of Medicine, Government Medical College, Jammu. Data of the patients on age, sex, underlying cause of CRF, duration and severity of CRF and duration of hemodialysis was collected. Attempt was made to establish the etiology of CRF by appropriate investigations in all cases. The patients were categorized into mild, moderate, severe CRF and end stage renal disease (ESRD) according to their creatinine clearance levels. They were examined thoroughly for any dermatological manifestation of CRF. Histopathological evaluation of biopsy specimen from normal looking skin of the left thigh and from any specific lesion was done to determine microscopic changes seen Introduction Abstract The present study was planned to evaluate the spectrum of clinical profile and histopathological changes in skin of CRF patients and to elucidate their association with the severity of disease process. One hundred diagnosed cases of CRF were studied. The patients were examined for any dermatological manifestation of CRF. Histopathological evaluation of normal looking skin and from specific lesions was done. The dermatological and histopathological changes were then correlated with the severity of renal failure. All patients had, at least, one cutaneous manifestation. Pruritis was the most common complaint (58%). Xerosis was the most frequent skin change (55%). Pallor was the most prevalent pigmentary change (93%). The most commonly observed hair change was diffuse alopecia (26%) and among nail changes, onchodystrophy and absence of lunula were the most frequent findings (19% each). Infections were seen in 19% cases and decreased sweating in 27% cases. The most common histopathological change seen was hyperkeratosis (91%) followed by epidermal atrophy (89%). The most common dermal change was perivascular lymphocytic infiltrate (62%) and the most frequent adnexal change was sweat gland atrophy (36%).CRF is associated with number of dermatological manifestations, some of which are related with the severity of renal disease. Early recognition and management of some of these dermatological manifestations may reduce the associated morbidity and vastly improve the cutaneous outcome in these patients.