Hautmanifestationen bei Nierenerkrankungen

Abstract

In addition to general skin changes like pallor or dryness and the frequent, often excruciating nephrogenic pruritus, specific diseases in patients with renal failure may occur. Acquired perforating dermatoses are usually also highly pruritic. Calciphylaxis is a severe disease with poor prognosis. Nonhealing wounds with superinfection and progression to sepsis are characteristic. Bullous lesions can be caused by disturbances in porphyrin metabolism. Nephrogenic systemic fibrosis is a disease which was first described in 2000. Its incidence is already on the decline. Furthermore, this article provides an overview of systemic diseases which have both skin symptoms and kidney changes. These include connective tissue diseases, vasculitis or sarcoidosis and amyloidosis. After a kidney transplantation, particular attention must be paid to the development of skin tumors and infections. The last part of this article is dedicated to genodermatoses with skin and renal involvement, where numerous causative mutations have already been characterized. Knowing the correlations of characteristic skin symptoms and specific, potentially life-threatening kidney disease is important in order to initiate further investigations and steps such as referral to nephrologists at an early stage.

Phenprocoumon based anticoagulation is an underestimated factor in the pathogenesis of calciphylaxis

“…Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare disease associated with chronic kidney disease (CKD). Crystals precipitate in the media of small cutaneous blood vessels presumably because of an imbalance of serum calcium- and phosphate-levels [1] as well as a disorder of metabolic modulators such as parathyroid hormone [2]. The resulting perivascular calcification provokes painful vascular obliteration, ulceration and necrosis.…”

“…The resulting perivascular calcification provokes painful vascular obliteration, ulceration and necrosis. The one-year-mortality ranges between 50 and 70% [1, 3] and is mainly due to infectious complications or sepsis. Patients suffering end-stage renal disease (ESRD) are predominantly affected by calciphylaxis, however, calciphylaxis also occurs in patients with moderately impaired or even normal renal function [4].…”