Skin barrier structure and function and their relationship to pruritus in end-stage renal disease

Abstract

Background. The relationship between dry skin and uraemic pruritus remains controversial. In addition, there is a lack of published data describing the structure and function of the stratum corneum (SC) in end-stage renal disease (ESRD). The purpose of the present study was to assess the function and structure of the skin barrier in patients with ESRD and to correlate any abnormalities with uraemic pruritus. Methods. Thirty-eight subjects participated in the study; 20 with ESRD and 18 healthy controls. Subjects underwent evaluation of SC integrity and permeability barrier recovery, SC surface pH, pruritus and dry skin. The content of glycerol, an important endogenous humectant, was assessed in D-squame tape strips from seven patients with ESRD. Skin biopsies from six of these patients were examined by electron microscopy using ruthenium tetroxide (Ru0 4 )-post-fixation. Results. Although SC integrity was impaired in ESRD patients (P ¼ 0.001), there were no significant differences in permeability barrier recovery rates between ESRD subjects and controls. However, there was a high significant negative correlation between SC glycerol content and dry skin in the arms of ESRD subjects (r ¼ À0.866, P ¼ 0.01). Yet, there was no consistent correlation between pruritus and either dry skin, SC integrity, glycerol content or surface pH. Electron microscopy revealed no significant ultrastructural abnormalities, with particular reference to the lipid bi-layer.Conclusions. SC integrity, but not permeability barrier recovery, is impaired in dialysis patients. Although dry skin in ESRD is associated with reduced SC glycerol levels, the ultra-structure appears to be unaffected.

Characteristics of Pruritus in Children on Peritoneal Dialysis

“…Several factors such as xerosis, mast cell reactivity, imbalance of divalent ions, high blood urea nitrogen (BUN) levels, hyperparathyroidism, cytokine release, neurogenic factors, opioid system involvement (understimulation of ĸ receptors or overexpression of µ receptors), bile acids, nitric oxide or some combination of these have been proposed as etiologic factors for uremic pruritus [5,7,8,9]. …”

“…The frequency and factors related to pruritus have previously been documented in adult patients on dialysis [2, 8, 9]. However, there are limited data regarding pruritus in children on PD.…”

Hot bath for the treatment of chronic renal failure

“…55 Although dry skin in ESRD is associated with reduced stratum corneum glycerol levels, permeability barrier and the ultrastructure appears to not be impaired in these patients. 56 By adding some decoction of Chinese medicine into warm water for bath, mediated bath is a traditional external treatment of CRF. The heat effect and absorption of active components of Chinese herbal medicine are the major reason for the curative effects.…”

Manifestações cutâneas na doença renal terminal

“…Phototherapy with UVA and UVB (narrow-band) is a good option, but in recommending this procedure, immunosuppression in kidney-transplanted patients and the potential risk of carcinogenesis should be considered. 19,[21][22][23][24][25] One of the rarest presentations is uremic frost, which occurs in only 3% of the patients with ESRD. 9 It is related to frank uremia and may be recognized as a white deposit on the skin, secondary to crystallized urea excreted in sweat.…”