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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 are the five vasculitic diseases that frequently involve both the kidneys and skin?

• Leukocytoclastic vasculitis
• Henoch-Schönlein purpura
• Polyarteritis nodosa
• Microscopic polyarteritis
• Wegener’s granulomatosis

When skin lesions suggestive of vasculitis occur, a skin biopsy should be done to confirm the diagnosis and determine the type of vessel and inflammation involved (see also Chapter 15). Vessel involvement may vary from small postcapillary venules (leukocytoclastic vasculitis) to medium-sized arteries (polyarteritis nodosa). If vasculitis is confirmed, testing should be done to determine if the kidneys are also involved.