Dermatology in Kidney Disease



A wide variety of skin conditions arise in patients with chronic kidney disease (CKD). These are sometimes related to the underlying pathologic process causing the renal disease but are also frequently associated with the uraemic state itself. Cutaneous examination of patients with CKD has shown an almost 100 % prevalence of skin disorders in dialysis populations [1], with a marked impact on quality of life [2]. In addition, there is over a 100-fold increase in the incidence of certain types of skin cancer in renal transplant recipients, placing a significant burden on healthcare resources as well as causing significant morbidity and in some cases mortality [3]. Early recognition of these skin problems can therefore avert such complications, making a basic knowledge of the dermatological conditions arising in the setting of renal disease extremely valuable to practising nephrologists.


Chronic Kidney Disease Skin Cancer Fabry Disease Merkel Cell Carcinoma Skin Condition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Professor Catherine Harwood and Dr Cate Orteu kindly provided many of the clinical photographs and contributed to sections “Skin Conditions Associated with Renal Transplantation” and “Skin Manifestations of Diseases Associated with Renal Involvement” of this chapter, respectively.


  1. 1.
    Udayakumar P, Balasubramanian S, Ramalingam KS, Lakshmi C, Srinivas CR, Mathew AC. Cutaneous manifestations in patients with chronic renal failure on haemodialysis. Indian J Dermatol Venereol Leprol. 2006;72(2):119–25.PubMedCrossRefGoogle Scholar
  2. 2.
    Moloney FJ, Keane S, O’Kelly P, Conlon PJ, Murphy GM. The impact of skin disease on renal transplantation on quality of life. Br J Dermatol. 2005;153(3):574–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348(17):1681–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis. 2007;50(1):11–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, Kondo D, Skatsume M, Maruyama S, Kazama JJ, Akazawa K, Gejyo F. Aetiology and prognostic significance of severe uraemic pruritus in chronic haemodialysis patients. Kidney Int. 2006;69:1626–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Wikström B, Gellert R, Ladefoged SD, Danda Y, Akai M, Ide K, Ogasawara M, Kawashima Y, Ueno K, Mori A, Ueno Y. Kappa-opioid system in uremic pruritus: multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16(12):3742–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis and outcome. J Am Acad Dermatol. 2007;56(4):569–79.PubMedCrossRefGoogle Scholar
  8. 8.
    Hayden MR, Goldsmith DJ. Sodium thiosulfate: new hope for the treatment of calciphylaxis. Semin Dial. 2010;23:258–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Broome DR. Nephrogenic systemic fibrosis associated with gadolinium based contrast agents: a summary of the medical literature reporting. Eur J Radiol. 2008;66(2):230–4.PubMedCrossRefGoogle Scholar
  10. 10.
    The Royal College of Radiologists – Gadolinium-based contrast media and Nephrogenic Systemic Fibrosis (2007).
  11. 11.
    Sontheimer RD. Subacute cutaneous lupus erythematosus: 25-year evolution of a prototypic subset (subphenotype) of lupus erythematosus defined by characteristic cutaneous, pathological, immunological, and genetic findings. Autoimmun Rev. 2005;4(5):253–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Gronhagen CM, Fored CM, Granath F, Nyberg F. Cutaneous lupus erythematosus and the association with systemic lupus erythematosus: a population-based cohort of 1088 patients in Sweden. Br J Dermatol. 2011;164:1335–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Chong BF, Song J, Olsen NJ. Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol. 2012;166:29–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Walsh JS, Gross DJ. Wegener’s granulomatosis involving the skin. Cutis. 1999;64(3):183–6.PubMedGoogle Scholar
  15. 15.
    Frances C, Du LT, Piette JC, et al. Wegener’s granulomatosis. Dermatological manifestations in 75 cases with clinicopathologic correlation. Arch Dermatol. 1994;130(7):861–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Moinzadeh P, Denton C, Krieg T, Black C. Fitzpatrick’s dermatology in general medicine, vol. 2, sect. 27. 8th ed. 2012. p. 1942–57.Google Scholar
  17. 17.
    Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol. 1995;32(1):45–59.PubMedGoogle Scholar
  18. 18.
    Orteu CH, Jansen T, Lidove O, Jaussaud R, Hughes DA, Pintos-Morell G, Ramaswami U, Parini R, Sundur-Plassman G, Beck M, Mehta AB; FOS Investigators. Fabry disease and the skin: data from FOS, the Fabry outcome survey. Br J Dermatol. 2007;157(2):331–7.Google Scholar
  19. 19.
    Hogarth V, Hughes D, Orteu CH. Pseudoacromegalic facial features in Fabry disease. Clin Exp Dermatol. 2013;38(2):137–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Lugo-Janer G, Sanchez JL, Santiago-Delphin E. Prevalence and clinical spectrum of skin diseases in kidney transplant recipients. J Am Acad Dermatol. 1991;24:410–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Akgül B, Cooke JC, Storey A. HPV-associated skin disease. J Pathol. 2006;208(2):165–75.PubMedCrossRefGoogle Scholar
  22. 22.
    Wisgerhof HC, Edelbroek JR, de Fijter JW, Haasnoot GW, Claas FH, Willemze R, Bavinck JN. Subsequent squamous- and basal-cell carcinomas in kidney transplant recipients after the first skin cancer: cumulative incidence and risk factors. Transplantation. 2010;89(10):1231–8.Google Scholar
  23. 23.
    Hofbauer GF, Bouwes Bavinck JN, Euvrard S. Organ transplantation and skin cancer: basic problems and new perspectives. Exp Dermatol. 2010;19(6):473–82.Google Scholar
  24. 24.
    Green A, Williams G, Neale R, Hart V, Leslie D, Parsons P, Marks GC, Gaffney P, Battistutta D, Frost C, Lang C, Russell A. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet. 1999;354(9180):723–9.Google Scholar
  25. 25.
    Harwood CA, Leedham-Green M, Leigh IM, Proby CM. Low-dose retinoids in the prevention of cutaneous squamous cell carcinomas in organ transplant recipients: a 16-year retrospective study. Arch Dermatol. 2005;141(4):456–64.PubMedGoogle Scholar
  26. 26.
    Euvrard S, Morelon E, Rostaing L, Goffin E, Brocard A, Tromme I, Broeders N, del Marmol V, Chatelet V, Dompmartin A, Kessler M, Serra AL, Hofbauer GF, Pouteil-Noble C, Campistol JM, Kanitakis J, Roux AS, Decullier E, Dantal J; TUMORAPA Study Group. Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med. 2012;367(4):329–39.PubMedCrossRefGoogle Scholar
  27. 27.
    Matin RN, Mesher D, Proby CM, McGregor JM, Bouwes Bavinck JN, del Marmol V, Euvrard S, Ferrandiz C, Geusau A, Hackethal M, Ho WL, Hofbauer GF, Imko-Walczuk B, Kanitakis J, Lally A, Lear JT, Lebbe C, Murphy GM, Piaserico S, Seckin D, Stockfleth E, Ulrich C, Wojnarowska FT, Lin HY, Balch C, Harwood CA, Skin Care in Organ Transplant Patients, Europe (SCOPE) group. Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases. Am J Transplant. 2008;8(9):1891–900.PubMedCrossRefGoogle Scholar
  28. 28.
    Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096–100.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Stallone G, Schena A, Infante B, Di Paolo S, Loverre A, Maggio G, Ranieri E, Gesualdo L, Schena FP, Grandaliano G. Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med. 2005;352:1317–23.PubMedCrossRefGoogle Scholar
  30. 30.
    National Institute for Health and Clinical Excellence. Improving outcomes for people with skin tumours including melanoma: the manual (2006 guidance).
  31. 31.
    Ismail F, Mitchell L, Casabonne D, Gulati A, Newton R, Proby CM, Harwood CA. Specialist dermatology clinics for organ transplant recipients significantly improve compliance with photoprotection and levels of skin cancer awareness. Br J Dermatol. 2006;155(5):916–25.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Harwood CA, Mesher D, McGregor JM, Mitchell L, L-Green M, Raftery M, Cerio R, Leigh IM, Sasieni P, Proby CM. A surveillance model for skin cancer in organ transplant recipients: a 22-year prospective study in an ethnically diverse population. Am J Transplant. 2013;13(1):119–29.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of DermatologyRoyal Free London NHS Foundation TrustLondonUK

Personalised recommendations