Uremic pruritus
| Uremic pruritus | |
|---|---|
| Other names | Uraemic pruritus or Renal pruritus[1] |
| Specialty | Dermatology  |
Uremic pruritus is caused by
Nalfurafine, an orally administered, centrally acting κ-opioid receptor agonist, is approved to treat the condition in Japan.[3]
Signs and symptoms
The signs and symptoms of uremic pruritus can vary. The intensity ranges from mildly uncomfortable to highly upsetting and causing agitation.
Causes
There are several potential causes of uremic pruritus, including immune dysregulation, uremic toxins,
Mechanism
Vitamin A,[6] parathyroid hormone,[7] calcium, phosphate, magnesium,[8] histamine,[9] and phosphate[8] are the most researched potential pruritogens in the pathophysiology of uremic pruritus.[4]
The etiology of uremic pruritus may involve the immune system as well. Research comparing hemodialysis patients with and without uremic pruritus revealed that those with the condition had noticeably higher levels of T helper 1 cells[10] as well as serum interleukin (IL)-6, IL-2,[11] and IL-31.[12][13]
In uremic pruritus, both peripheral and central
Diagnosis
Uremic pruritus is defined as itching that is directly caused by chronic kidney disease, with no other explainable conditions.[14] Uremic pruritus cannot be diagnosed with laboratory tests or established criteria because of its variability and lack of specific skin lesions. Comprehensive consideration of the diagnosis is necessary, encompassing neuropathic, psychogenic, renal, dermatologic, endocrine, hepatobiliary, hematologic, rheumatologic, oncologic, and endocrine causes.[4]
Treatment
The pathophysiology of uremic pruritus is still poorly understood, which contributes to the difficulty of current treatments.
It has been demonstrated that mast cell stabilizers, which stop mast cells from releasing inflammatory mediators, are useful in treating uremic pruritus. These stabilizers include zinc sulfate,[25] ketotifen,[26] oral cromolyn sodium,[27] and topical cromolyn sodium.[28]
See also
- Pruritus
- List of cutaneous conditions
References
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Further reading
- Rayner, Hugh C.; Larkina, Maria; Wang, Mia; Graham-Brown, Matthew; van der Veer, Sabine N.; Ecder, Tevfik; Hasegawa, Takeshi; Kleophas, Werner; Bieber, Brian A.; Tentori, Francesca; Robinson, Bruce M.; Pisoni, Ronald L. (September 18, 2017). "International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis". Clinical Journal of the American Society of Nephrology. 12 (12). Ovid Technologies (Wolters Kluwer Health): 2000–2007. PMID 28923831.
- Kim, Dana; Pollock, Carol (October 14, 2021). "Epidemiology and burden of chronic kidney disease-associated pruritus". Clinical Kidney Journal. 14 (Supplement_3). Oxford University Press (OUP): i1–i7. PMID 34987777.