Abstract
Objective
Kidney involvement secondary to psoriasis is a controversial issue. In this study, we evaluated the prevalence of urinary abnormalities in patients with psoriasis.
Materials and methods
Forty-five psoriasis patients (28 women, 17 men, mean age 44 ± 14 years) and 45 age- and gender-matched control subjects without hypertension or diabetes were enrolled in the study. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Urinalysis by dipstick and microscopic evaluation and 24-h proteinuria and albuminuria were measured in all patients and controls. Pathologic albuminuria was defined as albumin excretion of more than 30 mg/24 h. Renal biopsy was performed in psoriasis patients with urinary abnormalities.
Results
Patients with psoriasis and controls were not significantly different with respect to the prevalence of abnormal urinalysis (17.7% vs. 13.3%, P = 0.56), mean 24-h proteinuria (145 ± 66 mg/24 h vs. 141 ± 71 mg/24 h, P = 0.54), and albuminuria (21 ± 34 mg/24 h vs. 8 ± 9 mg/24 h, P = 0.31). However, patients with psoriasis had an increased prevalence of pathologic albuminuria compared with controls (24% vs. 2%, P = 0.005). PASI scores in psoriasis patients correlated significantly with 24-h albuminuria (r = 0.458, P = 0.007). Of the eight patients with psoriasis who had urinary abnormalities, four underwent renal biopsy. Two of them had biopsy-proven glomerulonephritis: mesangial proliferative glomerulonephritis in one and IgA nephropathy in the other.
Conclusion
The presence of abnormal urinalysis was not more common in patients with psoriasis than in controls. However, the increased prevalence of pathologic albuminuria and its positive correlation with psoriasis severity may suggest subclinical glomerular dysfunction in these patients.
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References
Lowes MA, Bowcock AM, Krueger JG (2007) Pathogenesis and therapy of psoriasis. Nature 445:866–873
Gudjonsson JE, Elder JT (2007) Psoriasis: epidemiology. Clin Dermatol 25:535–546
Griffiths CE, Voorhees JJ (1996) Psoriasis, T cells and autoimmunity. J R Soc Med 89:315–319
Heuvels J, Maximus A, Bosmans JL et al (1999) Renal abnormalities in psoriatic patients: a review. Nephron 82:1–6
Szepietowski JC, Szepietowski T (2000) Is renal function altered in patients with psoriasis vulgaris?–A short review. J Dermatol 27:569–572
Ahuja TS, Funtanilla M, de Groot JJ et al (1998) IgA nephropathy in psoriasis. Am J Nephrol 18:425–429
Alenius GM, Stegmayr BG, Dahlqvist SR (2001) Renal abnormalities in a population of patients with psoriatic arthritis. Scand J Rheumatol 30:271–274
Singh NP, Prakash A, Kubba S et al (2005) Psoriatic nephropathy–does an entity exist? Ren Fail 27:123–127
Akoglu H, Dede F, Akoglu G et al (2009) Membranoproliferative glomerulonephritis associated with psoriasis vulgaris. Ren Fail 31:858–861
Chapman JR (2011) Chronic calcineurin inhibitor nephrotoxicity-lest we forget. Am J Transplant 11:693–697
Widemann BC, Adamson PC (2006) Understanding and managing methotrexate nephrotoxicity. Oncologist 11:694–703
Madeddu P, Ena P, Glorioso N et al (1988) High prevalence of microproteinuria, an early index of renal impairment, in patients with diffuse psoriasis. Nephron 48:222–225
Cecchi R, Seghieri G, Gironi A et al (1992) Relation between urinary albumin excretion and skin involvement in patients with psoriasis. Dermatology 185:93–95
Szepietowski JC, Bielicka E, Wasik F et al (2000) Microalbuminuria as a subclinical marker of renal impairment in subjects with psoriasis vulgaris. J Eur Acad Dermatol Venereol 14:513–514
Jacobson CC, Kimball AB (2004) Rethinking the Psoriasis Area and Severity Index: the impact of area should be increased. Br J Dermatol 151:381–387
Doolan PD, Alpen EL, Theil GB (1962) A clinical appraisal of the plasma concentration and endogenous clearance of creatinine. Am J Med 32:65–79
Bossini N, Savoldi S, Franceschini F et al (2001) Clinical and morphological features of kidney involvement in primary Sjögren’s syndrome. Nephrol Dial Transplant 16:2328–2336
Jayne D (2009) Hematuria and proteinuria. In: Greenberg A (ed) Primer on kidney diseases. Saunders Elsevier, Philadelphia, pp 33–42
Viberti GC, Hill RD, Jarrett RJ et al (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1:1430–1432
Erley CM, Risler T (1994) Microalbuminuria in primary hypertension: is it a marker of glomerular damage? Nephrol Dial Transplant 9:1713–1715
Kaftan O, Kaftan B, Toppare MF et al (1996) Renal involvement in psoriasis. Dermatology 192:189–190
Zadrazil J, Tichy T, Horak P et al (2006) IgA nephropathy associated with psoriasis vulgaris: a contribution to the entity of ‘psoriatic nephropathy’. J Nephrol 19:382–386
Jiao Y, Xu H, Li H et al (2008) Mesangial proliferatative glomerulonephritis with or without IgA deposits: the morphological characters in psoriasis vulgaris. Nephron Clin Pract 108:221–225
Kim M, Ko Y, Yeo UC et al (1998) Psoriasis and glomerulonephritis. Clin Exp Dermatol 23:295–296
[No authors listed] (2002) National Kidney Foundation. K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39:1–266
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Dervisoglu, E., Akturk, A.S., Yildiz, K. et al. The spectrum of renal abnormalities in patients with psoriasis. Int Urol Nephrol 44, 509–514 (2012). https://doi.org/10.1007/s11255-011-9966-1
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DOI: https://doi.org/10.1007/s11255-011-9966-1