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Cutaneous Manifestations of Renal Disease

»	What types of skin changes are associated with renal disease?
»	What cutaneous findings occur in renal failure?
»	Do cutaneous signs of chronic renal failure resolve when the patient is treated with hemodialysis?
»	What cutaneous findings are present in patients being treated with dialysis?
»	Describe the nail changes in chronic renal failure.
»	What is uremic frost?
»	What causes the pallor of chronic renal failure?
»	What causes the pigmentary changes of the skin seen in chronic renal failure?
»	Is pruritus a common finding in all renal failure?
»	How is the pruritus of renal failure treated?
»	Are there skin changes associated with renal transplants?
»	What is transepidermal elimination? What is its relationship to kidney disease?
»	What are the differences between Kyrle’s disease, reactive perforating collagenosis, and perforating folliculitis?
»	Describe the porphyria-like eruption of dialysis.
»	What is Fabry’s disease?
»	Describe the skin lesions in Fabry’s disease.
»	What are the five vasculitic diseases that frequently involve both the kidneys and skin?
»	How should skin biopsy be used for the diagnosis of systemic amyloidosis?
»	What is nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy)?
»	What are some diseases that have both skin and renal manifestations?

What is uremic frost?

Although a rare finding today, this discoloration of the face was originally described as a classic manifestation of chronic renal failure. Whitish deposits were noted about the face and neck, believed to be due to deposition of crystallized urea from sweat. Table 38-2 summarizes the abnormalities of skin color associated with renal failure.

Walsh SR, Parada NA: Images in clinical medicine. Uremic frost, N Engl J Med 352:e13, 2005.

Table 38-2. Abnormalities of Skin Color Associated with Renal Failure
	SKIN FINDING	COLOR	DISTRIBUTION	ETIOLOGY
	Uremic frost	White	Face, nostrils, neck	Deposition of crystallized urea from sweat
	Pallor	Yellowish	Generalized	Anemia, urochrome deposition
	Hyperpigmentation	Brown	Photodistributed or generalized	Increased β-melanocyte stimulating hormone
	Bruising	Red-purple-green-yellow- brown	Sites of trauma	Hemostatic abnormalities