What causes pruritus in 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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Pruritus frequently affects the patient's sleep pattern and psychologic well-being. Cutaneous manifestations of pruritus include excoriations, prurigo nodularis, and lichen simplex chronicus. Mechanisms of uremia-induced pruritus are poorly understood and are believed to result from metabolic disequilibrium. Because pruritus is not seen with acute renal failure, changes in blood urea nitrogen (BUN) and creatinine are not solely responsible for this symptom. Some proposed causes of uremic pruritus include the following:

  • Xerosis

  • Decreased transepidermal elimination of pruritogenic factors

  • Hyperparathyroidism

  • Hypercalcemia

  • Hyperphosphatemia

  • Elevated histamine levels

  • Increased dermal mast cell proliferation

  • Uremic sensory neuropathy

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