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INTRODUCTION

KEY POINTS

  • All adults and children with renal disease can develop skin complications—these may arise from the uremic state or be due to the medical treatment received for the condition, for instance dialysis or kidney transplantation.

  • More than 20 million people aged 20 years or older in the United States alone have chronic kidney disease, which is fatal if not treated with dialysis or kidney transplantation.

  • The most important causes of chronic renal disease are diabetes and hypertension. Racial factors may play a role in the susceptibility to chronic renal failure because there is a strong association of hypertensive end-stage renal disease in African American families.

  • Cutaneous manifestations are to be expected in any patient who undergoes dialysis treatment. Many of the skin changes that occur in patients with chronic renal failure are also found in patients undergoing dialysis.

  • In contrast to dialysis treatment, cutaneous signs of renal failure may actually resolve if renal transplantation is successful.

  • However, posttransplant patients are at risk of developing primary cutaneous malignancies as well as cutaneous and mucosal lesions. It is particularly important to recognize the latter in pediatric patients with skin of color, as they are more common in African American and Hispanic children.

All adults and children with renal disease can develop cutaneous manifestations. These may arise from the uremic state as well as due to the medical treatments used to address the renal disease, for example, dialysis or kidney transplantation. Many of the systemic diseases that affect people with skin of color are diseases that result in the end-organ involvement of the kidney as part of the disease’s natural progression.

The major etiologies of renal disease in patients with skin of color are diabetes and hypertension. Other diseases linked to renal insufficiency include connective tissue diseases, systemic lupus erythematosus (SLE), scleroderma, gout, and sickle cell anemia. Advances in medicine have helped increase the life expectancy of people suffering from renal diseases, but treatment, which can include medications, dialysis, and renal transplantation, may encourage the development of associated dermatologic conditions.1

RENAL DISEASE

Chronic Kidney Disease and Failure

Chronic kidney disease (CKD) is a long-term condition defined by the gradual loss of kidney function. It is the precursor to end-stage renal disease (ESRD), which is fatal if not treated with dialysis or transplantation.

Epidemiology More than 20 million people aged 20 years or older in the United States alone suffer from CKD.2 It is more common among women than men and is found in more than 35% of patients with diabetes and in over 20% of patients with hypertension. According to statistics from the Centers for Disease Control and Prevention, almost 110,000 patients in the United States began treatment for ESRD in 2007.2 In the United States, 7 out of 10 new cases of ESRD in 2006 recorded either diabetes or hypertension ...

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