What is the role of dialysis in the dermatologic manifestations of end-stage renal disease (ESRD)?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

Many cutaneous disorders experienced by patients undergoing dialysis have little to do with the uremic syndrome and are related to the same underlying pathologic process that caused the renal disease. Because dialysis and transplant centers are required to report specific information regarding each patient diagnosed with end-stage renal disease (ESRD) to the United States Renal Data System (USRDS), data regarding the causes of ESRD are readily available in the Annual Data Report published by the USRDS.

Review of the 2019 report reveals that diabetes mellitus remains the most common cause of ESRD, responsible for approximately 42% of all patients on renal replacement therapy. [1] Hypertension accounts for approximately 26% of cases, and glomerulonephritis and cystic kidney diseases account for about 16%, although glomerulonephritis is not as prevalent as it was in the past. [1] The remaining causes of ESRD included vasculitis from an infectious or rheumatologic disease, interstitial nephritis, tumors, cholesterol emboli, and systemic amyloidosis. Infectious causes of glomerulonephritis included streptococcal infections, human immunodeficiency virus (HIV) infection, and hepatitis viral infections, both hepatitis C (HCV) and hepatitis B (HBV). [1]

Systemic lupus erythematosus (SLE) has been the most commonly reported rheumatologic cause of ESRD. Polyarteritis nodosa, granulomatosis with polyangiitis, Henoch-Schönlein purpura, scleroderma, and otherwise nonspecified vasculitides also were reported to have caused ESRD during this period. These systemic disorders and the associated renal diseases and cutaneous manifestations are tabulated in Table 1, below.

Table 1. Dermatologic Manifestations of Diseases Associated with the Development of ESRD (Open Table in a new window)

Systemic Disorder

Renal Disorder

Dermatologic Manifestations

Diabetes mellitus

Diabetic nephropathy

Diabetic dermopathy

Necrobiosis lipoidica

Acanthosis nigricans

Eruptive xanthomas

Kyrle disease

Scleredema

Systemic lupus erythematosus

Glomerulonephritis

Nephrotic syndrome

Purpura

Chronic cutaneous lupus

Subacute cutaneous lupus

Photosensitivity

Mucosal ulcers

Vasculitis

Tumid lupus

Systemic lupus erythematosus–associated neutrophilic dermatosis 

Henoch-Schönlein purpura

Glomerulonephritis

Vasculitis

Purpura

Granulomatosis with polyangiitis

Glomerulonephritis

Vasculitis

Purpura

Subcutaneous nodules

Ulcers

Polyarteritis nodosa

Glomerulonephritis

Vasculitis

Purpura

Subcutaneous nodules

Ulcers

Subacute bacterial endocarditis

Renal emboli

Glomerulonephritis

Petechiae

Purpura

Cholesterol emboli

Renal emboli

Petechiae

Livedo reticularis

Blue toes

Hepatitis C virus

Glomerulonephritis

Purpura

Porphyria cutanea tarda

Lichen planus

Sclerodermatous plaques

Cutaneous polyarteritis nodosa

Necrolytic acral erythema

Human immunodeficiency virus (HIV)

HIV-associated nephropathy

Eosinophilic folliculitis

Oral hairy leukoplakia

Bacillary angiomatosis

Kaposi sarcoma

Systemic sclerosis

Malignant hypertension

Diffuse scleroderma

Amyloidosis

Nephrotic syndrome

Purpura

Macroglossia

Fabry disease

Nephrotic syndrome

Angiokeratomas

Nail-patella syndrome

Renal tubular defects

Absent/displaced patella

Absent/pitted nails

Tuberous sclerosis

Renal hamartomas

Renal cell carcinoma

Adenoma sebaceum

Ash-leaf macule

Periungual fibromas

Shagreen patch

ESRD = end-stage renal disease


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