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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Calciphylaxis is a rare, severe complication of secondary hyperparathyroidism. Patients present with painful, violaceous, mottled skin lesions of the upper and lower extremities, which become necrotic and produce nonhealing ulcers. Gangrene of fingers and toes frequently requires amputation, produces nonhealing wounds, and can lead to sepsis and death. We reviewed the clinical course of five patients with calciphylaxis treated in our institution. The three men and two women (aged 47 to 72 years) had secondary hyperparathyroidism from chronic renal failure. All patients had severe pruritus, painful ulcers, and severe hyperphosphatemia with elevated serum calcium-phosphate product (greater than 12 mmol2/L2), but the serum parathyroid hormone levels were only moderately elevated. Most patients had medical calcification of medium and small blood vessels, and some had soft-tissue calcification visible on roentgenography. Treatment consisted of local wound care, antibiotics, phosphate-binding agents, and parathyroidectomy. Two patients died of uncontrollable sepsis. The three survivors had dramatic improvement of pain and ulcers after parathyroidectomy. Calciphylaxis is a limb- and life-threatening complication of secondary hyperparathyroidism. Diagnosis can be made by recognizing the characteristic painful skin lesions, ulcers, and gangrene of the digits, and patients should be treated with subtotal parathyroidectomy.
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PMID:Calciphylaxis in secondary hyperparathyroidism. Diagnosis and parathyroidectomy. 192 21

Pruritus is a common symptom associated with chronic renal failure (CRF). But increased plasma histamine levels and skin mast cell proliferation previously reported in these patients did not correlate with the intensity of the pruritus. Since increased mast cell releasability was described in chronic idiopathic urticaria, we attempted to examine whether this mechanism could explain pruritus in patients with CRF. Twenty-five patients with end stage renal failure were skin tested with histamine, codeine, and compound 48/80. There were nine patients on continuous ambulatory peritoneal dialysis, eight patients on hemodialysis, (tested both before and after dialysis) and eight patients with advanced CRF. Wheal area after intradermal injection of three concentrations of the above substances was measured. In general, the wheal areas in all patients with CRF were either similar to or smaller than those of the control group who were without renal impairment. In conclusion, patients with CRF with or without dialysis therapy demonstrated unchanged or decreased skin test responses to histamine, codeine, and compound 48/80. Increased mast cell releasability cannot explain the pruritus in patients with CRF.
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PMID:Cutaneous responses to histamine, compound 48/80, and codeine in patients with chronic renal failure. 195 8

Plasma histamine concentrations were measured using a commercially available monoclonal antibody radioimmunoassay in 38 patients with nephrotic syndrome, end stage renal failure, those receiving haemodialysis, and those receiving continuous ambulatory peritoneal dialysis to determine whether histamine may mediate damage to glomerular capillaries and arterial endothelium. Plasma histamine concentrations were significantly increased in all four patient groups when compared with those of controls and were the highest in two patients with pruritus. Raised plasma histamine concentrations in such patients are consistent with the hypothesis that histamine may contribute to the damage to glomerular capillaries and to arterial endothelium. These effects may be relevant to the pathogenesis of glomerular disease and atherosclerosis. Histamine may also contribute to the pathogenesis of pruritus in patients with chronic renal failure.
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PMID:Plasma histamine in patients with chronic renal failure and nephrotic syndrome. 201 27

Renal excretion is the major route of magnesium elimination from the body and a positive magnesium balance would be expected under conditions of renal insufficiency. However, a compensatory decrease in tubular reabsorption is operating to maintain an adequate urinary magnesium excretion even when glomerular filtration rates are very low. Nevertheless, in end-stage renal disease, the limited ability of the kidney to excrete an increased magnesium load may result in toxic concentrations of the ion in serum. While magnesium intoxication is a real hazard when magnesium-containing drugs are given, magnesium balance may be normal or even decreased in uraemic patients. This is usually due to decreased dietary intake combined with the impaired intestinal magnesium absorption which characterizes chronic renal failure. Impairment of magnesium absorption seems to be related to deficient synthesis of the active metabolite of vitamin D by the non-functioning kidney. Following the institution of chronic haemodialysis or continuous ambulatory peritoneal dialysis (CAPD) treatment, the major determinant of magnesium balance is the concentration of magnesium in the dialysate. Changes in the dialysate magnesium have been used to reduce the incidence of renal osteodystrophy, to alleviate uraemic pruritus, or to retard the development of arterial calcification in chronic renal disease. However, uncertainty about magnesium, calcium and parathyroid hormone relationships in renal failure makes a reasoned approach to such manipulations extremely difficult.
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PMID:Magnesium metabolism in chronic renal failure. 213 26

1. We determined plasma levels of histamine in uraemic patients and examined their correlation with the presence of pruritus. 2. In 27 patients with chronic renal failure, plasma histamine levels were analysed by radioimmunoassay and were compared with those of 40 healthy adult subjects. The control population showed plasma histamine concentrations of 185 +/- 33 pg/ml, which were significantly lower than those of the patients with renal insufficiency. The highest levels (552 +/- 116 pg of histamine/ml) were found in 16 patients with chronic renal failure (mean serum creatinine 5.1 +/- 1.0 mg/dl) and severe itching. 3. Twelve patients with pronounced pruritus who were on maintenance haemodialysis (serum creatinine 9.2 +/- 1.2 mg/dl) had a mean plasma histamine concentration of 515 +/- 81 pg/ml. Fifteen patients on regular haemodialysis (serum creatinine 9.0 +/- 1.5 mg/dl) and who experienced itching had plasma histamine levels (322 +/- 40 pg/ml) which were significantly lower (P less than 0.01) than those of the patients with pruritus but which were elevated compared with those of the control population (P less than 0.01). 4. No correlation could be found between increased plasma histamine levels and the type of dialysis membrane used or the method of sterilization of the membrane. 5. Haemodialysis alone did not reduce plasma histamine concentrations, although high concentrations could be detected in the ultrafiltrate. In six patients a rapid decrease in plasma histamine concentration from 565 +/- 134 pg/ml to within the normal range could be detected after 60 min of combined haemodialysis and haemoperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased plasma histamine levels in uraemic pruritus. 217 15

The pharmacokinetics of quinapril, a novel angiotensin converting enzyme (ACE) inhibitor, and its active metabolite, quinaprilat, were determined following a single 20-mg oral dose of quinapril in six patients with chronic renal failure maintained on continuous ambulatory peritoneal dialysis (CAPD). Overall, quinapril was well tolerated by these CAPD patients, with mild and transient side effects, not unexpected in this clinical setting, which included pruritus, headache, nausea, and cough. Blood pressure reduction was observed in four of six patients, with onset reliably two to four hours after dosing and duration up to 48 hours, associated with quinaprilat concentrations in plasma above 90 ng/mL for at least 33 hours postdose. Two patients experienced significant hypotension, systolic blood pressure below 90 mm Hg, which responded promptly to oral fluid administration and/or reduction in dialysate tonicity. The pharmacokinetic profile of quinapril in these CAPD patients was not significantly different from that previously observed in healthy subjects with normal renal function and in patients with moderate to severe renal dysfunction not yet requiring dialysis (RDND). The apparent elimination half-life of quinapril was approximately one hour, with negligible dialysate excretion. The pharmacokinetic profile of quinaprilat in these CAPD patients was similar to that previously observed in patients with RDND. The elimination half-life of quinaprilat was markedly prolonged when compared to that in healthy subjects and averaged 20 hours, with only a small amount of quinaprilat excreted in dialysate (mean = 2.6% of total dose).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacokinetics of quinapril and its active metabolite quinaprilat during continuous ambulatory peritoneal dialysis. 227 86

Dry-looking skin of unknown etiology develops in a majority of patients with chronic renal failure. The hydration of the stratum corneum influences the appearance of the skin and lack of water is considered to induce roughness, e.g. in atopic dermatitis. The aim of the present study was to compare the water content in uremic and healthy skin and to evaluate the possible relationship between skin hydration and pruritus in uremic patients. Thirty-one patients, 19 with pruritus, undergoing chronic hemodialysis participated. Twelve healthy age-matched subjects served as controls. The skin of the uremic patients appeared generally xerotic, whereas the controls had normal-looking skin. The water content of the stratum corneum was recorded with the Corneometer, a capacitance-measuring device, on three different sites: the neck, the chest and the lower leg. There was a significant difference in water content between locations in all groups, the water content being highest in the neck and lowest in the leg (p less than 0.01). There was a tendency that patients with pruritus had a lower water content than patients without pruritus, but there was no significant difference between uremic patients and controls. Hence, insufficient hydration does not seem to explain the difference in skin texture between uremic patients and healthy subjects.
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PMID:Stratum corneum hydration in patients undergoing maintenance hemodialysis. 246 93

Pruritus is frequently observed in hemodialyzed patients; its etiology seems to be multifactorial. Increased plasma histamine levels have been reported in chronic renal failure. As histamine is a potent inducer of pruritus. The authors investigated its concentrations and kinetics in plasma of stable hemodialyzed patients.
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PMID:Plasma histamine levels and kinetics in chronic hemodialysis patients. 259 57

To record the potentially serious side-effects of melanoma and non-melanoma skin cancers and ocular damage following long-term PUVA chemotherapy, we re-examined 198 of 242 patients. These comprised: 90 with psoriasis, 27 with parapsoriasis, 19 with cutaneous T-cell lymphoma, 23 with vitiligo, eight with cutaneous mastocytosis, 16 with atopic dermatitis, three with prurigo nodularis, two with polymorphous light eruption and 10 with pruritus of chronic renal failure on dialysis, treated between 1977 and 1987 in our department. During the 10-year period, 11 patients died of unrelated disease. None of the patients reviewed had previous skin cancer or had been treated with arsenic, methotrexate or ionizing irradiation before PUVA treatment. None of the patients were children under 16 years of age. The mean age was 54.5 years, the sex ratio 102:96 (M:F). The mean cumulative dose of UVA for the whole group was 169.5 J/cm2. One patient with psoriasis, psoriatic arhropathy, ankylosing spondylitis and Crohn's disease, who was on azathioprine for 6 years, developed squamous-cell carcinoma on the left lower leg. Another patient with pustular psoriasis, who received PUVA treatment to her palms and soles only, developed malignant lentigo of Hutchinson on the right lower leg. PUVA lentigines were found in about 20% of patients. All patients had a yearly ophthalmological examination. None of them developed cataracts, lens opacities or had impairment of their visual acuity.
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PMID:Cutaneous and ocular side-effects of PUVA photochemotherapy--a 10-year follow-up study. 269 Nov 34

Itching is the dermatologic symptom more often found in patients with chronic renal failure. We have studied 80 patients with end-stage renal disease; itching was present in 56.3% of the cases. We didn't detected in this study any correlation between itching, long term hemodialysis, high calcium, phosphorus, alkaline phosphatase or phosphocalcic product levels. We have seen: 1. Those patients with itching were older than the rest. 2. Itching was important in those patients with residual diuresis less than 500 ml/day (p greater than 0.01). 3. Those men without itching had higher hematocrit levels (p greater than 0.01). 4. Histologic findings on optic and electronic microscopy were more frequent in patients who presented this symptom.
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PMID:[Pruritus in chronic kidney insufficiency]. 269 31


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