What are the other Names for this Condition (Also known as/Synonyms)

• Chronic Kidney Disease Associated Pruritus
• Pruritus in Renal Failure 
• Uraemic Pruritus

What is Uremic Pruritus? (Definition/ Background Information)

• Uremic Pruritus refers to the condition of severe itching of skin due to underlying kidney failure. As many as half of the individuals with chronic kidney disease or end-stage kidney disease may be affected by Uremic Pruritus. Hence, the condition is also known as Pruritus in Renal Failure
• The term ‘uremic’ refers to abnormal levels of electrolytes and end-products of body metabolism (such as urea and creatinine) in blood that usually occurs due to renal failure. The term ‘pruritus’ means severe itching of skin due to an underlying health condition
• The cause of Uremic Pruritus is not well-established. Researchers believe that it may be an inflammatory skin condition or one that is associated with renal dialysis
• Apart from persistent itching, the signs and symptoms of Uremic Pruritus may include development of superimposed infections, loss of sleep due to night-time itching, and severe psychological stress
• The treatment of Uremic Pruritus involves the use of topical soothing creams and lotions, medications, and ultraviolet light therapy. The prognosis of the condition is dependent on the severity of the underlying kidney failure

Who gets Uremic Pruritus? (Age and Sex Distribution)

• Uremic Pruritus may be observed in about 1 in 2-5 individuals with renal failure
• Individuals of any age, children or adults, may be affected
• It is observed in both males and females
• No particular racial or ethnic predominance is noted

What are the Risk Factors for Uremic Pruritus? (Predisposing Factors)

• Uremic Pruritus is seen against a background of kidney failure; no other risk factors are noted
• The cause of kidney failure has no bearing on the development of Uremic Pruritus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Uremic Pruritus? (Etiology)

The cause of development of Uremic Pruritus is unknown. It is only observed in individuals with chronic kidney disease or end-stage renal disease, and not in individuals with acute kidney failure.

• Several factors have been implicated as contributing to the cause, such as dry skin (xerosis), other associated conditions, such as diabetes and liver disease, abnormal calcium and phosphorus levels, etc.
• High levels of C-reactive protein and other cytokines in blood seem to indicate an inflammatory basis for the development of Uremic Pruritus
• It is reported that chronic itching heightens the itch sensation of the central nervous system by bringing about certain changes in the skin and nervous system

In general, individuals with renal failure need to undergo regular dialysis, which include either of the two types - hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). However, with respect to the cause of Uremic Pruritus -

• Both hemodialysis and peritoneal dialysis patients are seen with Uremic Pruritus; it occurs irrespective of the type of dialysis provided
• Some reports indicate that individuals undergoing CAPD have decreased incidence rates of renal pruritus than those undergoing hemodialysis

What are the Signs and Symptoms of Uremic Pruritus?

Individuals with Uremic Pruritus may present the following signs and symptoms:

• Severe itching (pruritus); it can be localized to a region or widespread across the body
• Itching may be continuous or intermittent; it may be more severe during the nights
• The itching starts a few days after dialysis and is less on the days of dialysis
• Irregular scratch marks, red rashes, and skin sores may be seen
• Skin discoloration and bruising (ecchymosis)
• Dry skin is seen in Uremic Pruritus affected individuals, which can aggravate the condition
• The arms, abdomen, and head are affected, but the most common site is the back
• The skin may develop scales and lichenify (thicken, as in eczema) over time

Individuals with diabetes-associated renal failure may develop nodular lesions from long-term itching.

How is Uremic Pruritus Diagnosed?

The diagnosis of Uremic Pruritus may involve the following tests and studies:

• Complete evaluation of medical history, along with a thorough physical examination
• Assessment of the signs and symptoms
• Radiological and laboratory tests related to renal failure

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Uremic Pruritus?

The potential complications of Uremic Pruritus include:

• Uremic Pruritus can severely disrupt sleep and affect the quality of one’s life
• Stress and depression are often noted
• Development of secondary bacterial and fungal skin infections
• Other complications due to underlying kidney failure
• The condition may be resistant to treatment in some individuals

How is Uremic Pruritus Treated?

The treatment of Uremic Pruritus may involve the following measures:

• Ensuring proper skin care
• For initial treatment and dry skin issues, moisturizing creams and topical applications are used. These include petroleum jelly, menthol, capsaicin for local itchiness, and tacrolimus that is known to be very effective in many individuals
• The use of antihistamines/steroids have brought limited results
• Administration of doxepin and mirtazepine in controlled manner; other medications used in treating allergies
• Treatment also includes phototherapy using ultraviolet light (UVB) for severe cases
• Administration of gabapentin (used to treat neurological conditions) and opiate antagonists (naloxone)
• Addressing iron deficiencies through adequate supplementation
• Renal replacement therapy such as dialysis or renal transplant (as necessary)

How can Uremic Pruritus be Prevented?

Currently, there are no suitable measures available to prevent Uremic Pruritus in individuals with renal failure.

What is the Prognosis of Uremic Pruritus? (Outcomes/Resolutions)

The overall prognosis of Uremic Pruritus is based on the underlying kidney failure and its treatment.

• It is reported that by improving kidney dialysis quality (such as by taking suitable measures to control calcium and phosphorus levels), the incidence of Uremic Pruritus and its severity may be decreased
• Individuals, who undergo a kidney transplantation, may find complete resolution of the condition
• Complications, such as absence of sleep and presence of severe depression, can adversely influence the prognostic values

Additional and Relevant Useful Information for Uremic Pruritus:

Another very pruritic rash associated with renal failure is perforating disease of renal failure.

Please visit our Kidney & Bladder Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/kidney-health/