Dermatologic manifestations of renal disease are not uncommon findings in patients with end-stage renal disease (ESRD). Cutaneous examination of patients with ESRD has shown that 50-100% of patients have at least 1 dermatological condition. A high prevalence of cutaneous disorders is expected, because most patients with ESRD have an underlying disease process with cutaneous manifestations. In addition, uremia and conditions associated with renal replacement therapy are fraught with numerous and, often, relatively unique cutaneous disorders. Consequently, dermatologic manifestations of renal disease may be divided into 3 general categories including:
- Dermatologic manifestations of diseases associated with the development of ESRD
- Dermatologic manifestations of uremia
- Dermatologic disorders associated with renal transplantation.
Hands of a transfusion-dependent patient on long-term hemodialysis. Several uremia-related cutaneous disorders are visible. The pigmentary alteration results from retained urochromes and hemosiderin deposition. The large bullae are consistent with either porphyria cutanea tarda or the bullous disease of dialysis. All nails show the distal brown-red and proximal white coloring of half-and-half nails.
This article does not discuss systemic disorders, because most of them are discussed in other articles in Medscape Reference. The purpose of this article is to integrate renal and cutaneous aspects of disease as well as highlight some important, although frequently underappreciated, clinical or laboratory findings that ally renal and skin diseases. Recognition of the details may provide clinicians with greater insight into the management of patients.
The image below illustrates several uremia-related cutaneous disorders.