The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients

Kimmel, Martin; Alscher, Mark Dominik; Dunst, Robert; Braun, Niko; Machleidt, Christoph; Kiefer, Thomas; Stülten, Christina; Kuip, Heiko van der; Pauli‐Magnus, Christiane; Raub, Ulrich; Kuhlmann, Ulrich; Mettang, Thomas

doi:10.1093/ndt/gfi204

Cited by 185 publications

(175 citation statements)

References 18 publications

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“…The exact pathophysiology of uremic pruritus is unknown, but it is likely multifactorial. Possible etiological factors are presented in Table 2 (11)(12)(13)(14)(15). There is conflicting evidence regarding the relationship between the onset and severity of pruritus and the duration of ESRD and dialysis therapy (11,12,16).…”

Section: Nonspecific Manifestationsmentioning

confidence: 99%

Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

154

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SummaryA broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.

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Section: Nonspecific Manifestationsmentioning

confidence: 99%

Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

154

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“…Kimmel et al (32) found that CRP and IL-6 were higher in HD patients with UP compared with HD patients without UP. Kimmel et al realized that, among the same patients, the ratio of Th1 (measured using CXCR3 as a chemokine receptor and IFN-γ) to Th2 (measured by CCR4 as a chemokine receptor and IL-4) were also higher.…”

Section: Discussionmentioning

confidence: 99%

Effects of Fumaria parviflora L on Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Akrami

Hashempur

Tavakoli

et al. 2016

Jundishapur J Nat Pharm Prod

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Background: Uremic pruritus (UP) is a common, bothersome symptom in hemodialysis (HD) patients with end-stage renal disease. Immunohypothesis is currently favored as an explanation of the cause of UP. Fumaria parviflora L (FP) is a medicinal herb with several pharmacological properties, including prominent anti-inflammatory activity. Objectives: This study aimed to assess the efficacy of FP for reducing UP severity among HD patients. Methods: A total of 79 HD patients with pruritus were randomly assigned to receive either FP or a placebo for eight weeks. The visual analogue scale (VAS), the Duo score for calculating pruritus score, serum interferon-γ (IFN-γ) level, interleukin-4 (IL-4), and high-sensitivity C-reactive protein were measured in the patients before and after treatment. Results: At the end of the treatment phase, the pruritus score decreased in both groups (P < 0.001); however, the mean reduction

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“…Neuere Untersuchungen deuten außerdem darauf hin, dass eine Mikroinflammation in der Haut zur Entstehung des urämischen Pruritus beitragen könnte. Zum Beispiel wurde gezeigt, dass sich bei Dialysepatienten mit Pruritus eine relative Vermehrung der pro-inflammatorisch bedeutsamen TH1-Zellen und erhöhte IL-6-Spiegel nachweisen lassen [27]. Eine entzündungsgetriggerte Verringerung der calciumbindenden Proteine hingegen scheint nicht vorzuliegen [28].…”

Section: Histaminrezeptorenunclassified

Pathogenese des Pruritus

Ständer

Raap

Weißhaar

et al. 2011

J Deutsche Derma Gesell

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Keywords• itch • pruritus • pain • atopic dermatitis • sensory nerves • urticaria Zusammenfassung Die Pathogenese von akutem und chronischem Pruritus (über 6 Wochen Dauer) ist komplex und involviert in der Haut ein Netzwerk aus residenten (z. B. Mastzellen, Keratinozyten, sensorische Neurone) und transienten inflammatorischen (z. B. eosinophile Granulozyten) Zellen. Aktuelle Untersuchungen konnten zeigen, dass sich trotz überlappender Mechanismen die Pathogenese von Pruritus und Schmerz in wesentlichen Punkten unterscheidet. In der Haut wurden die sensorischen C-Nervenfasern intensiv untersucht. Verschiedene Klassen von Histamin-sensitiven und nicht-Histamin-sensitiven C-Fasern wurden beschrieben. Epidermalen und dermalen sensorischen Nervenfasern wird eine wichtige Rolle bei der kutanen Pruritusinduktion zugeschrieben. Sie interagieren mit Keratinozyten und inflammatorischen Zellen wie z. B. T-Lymphozyten, Eosinophilen und Basophilen, welche eine Vielzahl pruritogener Mediatoren (z. B. Nervenwachstumsfaktoren, Interleukin 31) freisetzen und die lokalen Nervenfasern erregen, sensibilisieren und zum Aussprossen bringen können. Spezifische Rezeptoren, die ausschließlich bei der Induktion von Pruritus eine Rolle spielen, wurden auf kutanen und spinalen Neuronen identifiziert. Vor kurzem wurde der Gastrin-releasing peptide receptor (GRPR) auf spinalen Neuronen nachgewiesen, die Pruritus, aber nicht Schmerz vermitteln. Chronischer Pruritus ist nach wie vor schwer zu behandeln. Die aktuellen Erkenntnisse zur Pathogenese des Pruritus erlauben die Entwicklung neuer Zielstruktur-orientierter Therapieansätze. Zum Beispiel wurde kürzlich gezeigt, dass Kappa-OpioidrezeptorAgonisten und Neurokinin-1-Antagonisten chronischen Pruritus lindern können. SummaryThe pathogenesis of acute and chronic (> 6 weeks duration) pruritus is complex and involves in the skin a network of resident cells (e. g., mast cells, keratinocytes, sensory neurons) and transient inflammatory cells (e. g., eosinophils). Though pruritus and pain show overlapping mechanisms, recent studies have provided evidence that pruritus and pain pathogenesis differ in important points. In the skin, the sensory C-nerve fibers have been investigated intensively. Several classes of histamine-sensitive or histamine-insensitve C-fibers have been described. Epidermal and dermal sensory nerve fibres are

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The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients

Abstract: These results point to a central role of inflammation in the pathogenesis of UP in HD patients.

Cited by 185 publications

References 18 publications

Cutaneous Manifestations of ESRD

Cutaneous Manifestations of ESRD

Effects of Fumaria parviflora L on Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Pathogenese des Pruritus

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