Uremic pruritus

Uremic pruritus (also known as uremic itch, renal itch, end-stage renal disease-associated pruritus, or ESRD-associated pruritus) is a common and often severe symptom in patients with advanced or end-stage kidney disease. It is characterized by an intense itching sensation, which can significantly impact the quality of life and general well-being of affected individuals.

Etiology

The exact cause of uremic pruritus is not fully understood, but it is believed to be multifactorial. Factors that may contribute to the development of this condition include hyperparathyroidism, hyperphosphatemia, anemia, iron deficiency, calcium-phosphate imbalance, and neuropathy. Other potential contributing factors include xerosis (dry skin), immune system dysfunction, and neurological abnormalities.

Clinical Presentation

Patients with uremic pruritus typically present with an intense itching sensation that can be generalized or localized. The itch is often worse at night and can interfere with sleep. Other symptoms may include xerosis, lichenification (thickening of the skin), and excoriation (skin damage caused by scratching).

Diagnosis

The diagnosis of uremic pruritus is primarily based on clinical presentation and the presence of advanced or end-stage kidney disease. Laboratory tests may be used to identify potential contributing factors, such as hyperparathyroidism, hyperphosphatemia, anemia, and iron deficiency.

Treatment

Treatment of uremic pruritus is challenging and often requires a multimodal approach. This may include pharmacological treatments, such as antihistamines, opioid receptor antagonists, and gabapentinoids, as well as non-pharmacological interventions, such as phototherapy, acupuncture, and skin care measures.

Prognosis

The prognosis of uremic pruritus varies and is largely dependent on the underlying kidney disease and the effectiveness of the treatment measures implemented. In some cases, the itch may persist despite treatment, significantly impacting the patient's quality of life.

See Also

• Chronic kidney disease
• Pruritus
• Dialysis

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