What is Nephrology - What other dermatologic signs of kidney illness are there?
Xerosis, or dry skin, is common among dialysis patients, particularly on the extensor regions of the extremities. It can cause generalized pruritus and is inconvenient. Increased levels of melanocyte-stimulating hormone and consequent deposition of melanin in the basal layer of the epidermis have been linked to changes in pigmentation, particularly hyperpigmentation. The deposition of lipochrome pigment and carotenoids in the dermis and subcutaneous tissues may induce a "sallow" coloring of the skin in some patients. As a result of chronic kidney illness, pallor is frequently coupled with variable degrees of anemia. In circumstances of untreated and severe kidney illness, uremic frost refers to the deposition of crystalline urea released from perspiration in the epidermis. Ecchymosis is frequently linked to uremic platelet dysfunction. Lindsay nails, often referred to as "half and half nails," are a pale discoloration of the proximal half of fingernails that is thought to be caused by edema of the nail bed and underlying capillary network. African Americans with diabetes mellitus are more likely to develop acquired perforating dermatosis (Kyrle disease). The lesions are pruritic and include a linear confluence of papules with a central, oyster shell–like keratotic plug. They can be found on the trunk, proximal extremities, scalp, and face. An inflammatory skin reaction caused by the presence of uremic toxins, uric-acid deposits, or scratching-induced damage are all possible causes. Porphyria cutanea tarda (PCT) is a vesiculobullous illness that affects the dorsum of the hands and feet, but it can affect any sun-exposed area. Sclerodermoid plaques (facial hyperpigmentation) and hypertrichosis are frequently seen. Increased uroporphyrin levels are frequently the cause. The cornerstone of management is avoiding sun exposure. Use of high-flux dialysis membranes (to improve dialysis performance) and small-volume weekly phlebotomies in extreme, rare situations are further options for lowering uroporphyrin levels. Alcohol consumption, estrogen and iron supplementation, and persistent infections are all common triggering factors (e.g., hepatitis B or C virus, human immunodeficiency virus). Pseudoporphyria, which is clinically identical to PCT but has normal uroporphyrin levels, is a common differential diagnosis.
0 Comments
What is Nephrology – What is Nephrogenic Systemic Fibrosis ?
NSF (nephrogenic systemic fibrosis) is a type of systemic fibrosis that affects the kidneys. NSF (nephrogenic fibrosing dermopathy) is characterized by gradual fibrosis and thickening of the skin (similar to scleroderma), which is very painful, as well as fibrosis in other organs (e.g., pleura, diaphragm). Plaques, papules, or nodules show as asymmetrically distributed plaques, papules, or nodules over the distal extremities. Deposition of gadolinium (a contrast substance used in magnetic resonance imaging) that is not removed in the presence of severe chronic renal disease or acute kidney damage is the etiology. The time between gadolinium exposure and the onset of NSF symptoms might range from 2 days to 18 months. This variation is due to gadolinium mobilization from bone over time. When opposed to macro cyclic gadolinium compounds, the risk of NSF appears to be higher with linear molecules (e.g., gadodiamide). Because NSF has no effective treatment and a significant mortality rate, prevention is the primary goal. In individuals with severe chronic kidney disease or acute kidney injury, gadolinium-enhanced scans should be avoided. In patients with advanced chronic renal disease, hemodialysis (HD; removes 92 percent of gadolinium after two HD sessions; 99 percent after three HD sessions) has been described as a preventative strategy when gadolinium-enhanced scans are required. Similarly, a high-intensity peritoneal dialysis (PD) program can remove gadolinium (90 percent of the gadolinium in two days with 10 to 15 PD exchanges each day). It is unclear whether these efforts are successful. What is Nephrology - What is the definition of calciphylaxis?
Calcific uremic arteriolopathy (CUA), commonly known as calciphylaxis, is a painful condition characterized by purpuric plaques and nodules under the skin. In severe disease, these nodules may necrose. Despite the severe skin manifestations, it's best to conceive of it as a systemic disease that needs to be treated promptly due to its high fatality rate. When the extremities are implicated, the lesions are commonly described as a mottled or violaceous discoloration with a reticular pattern, comparable to livedo reticularis (seen in atheroembolic kidney disease, antiphospholipid syndrome, and cryoglobulinemia) and are bilateral and symmetric in distribution. It's worth noting that those with proximal lesions (trunk, buttocks, and thighs) have a worse prognosis than those with more distal lesions (forearms and fingers; calves and toes). Poorly treated secondary hyperparathyroidism, uncontrolled diabetes mellitus, obesity, female sex, duration of renal replacement treatment, history of skin damage, and use of warfarin are all known risk factors for CUA. Increased expression of osteopontin and bone morphogenic protein 4 suggests that inducers of vascular calcification play a key role in the disease's etiology. Suspicion is essential for early detection. When cancer is detected early on (nonulcerative), treatment interventions have been found to enhance prognosis. The key to managing CUA is prevention. Controlling secondary hyperparathyroidism aggressively is critical. One of the treatments for established CUA is sodium thiosulfate. It is thought to work through two mechanisms: 1. Removes calcium from soft tissues by chelating it. 2. Antioxidant, enhancing local blood flow and soft tissue oxygenation by stimulating endothelial nitric oxide synthesis. 5 to 25 g of intravenous (IV) Na thiosulfate delivered toward the end of dialysis for several weeks to months is a standard treatment regimen. Although there is minimal data, bisphosphonates (IV pamidronate and ibandronate, and PO etidronate) may be useful in modifying ectopic calcium phosphate deposition and directly suppressing calcification via the nuclear factor F06BF06BB cascade. Hyperbaric oxygen therapy enhances oxygen supply to damaged tissues by increasing oxygen partial pressure; it also aids wound healing by promoting phagocytosis and angiogenesis while reducing tissue edema. What is Nephrology - What role does itching play in renal illness, and how can you deal with it?6/7/2022 What is Nephrology - What role does itching play in renal illness, and how can you deal with it?
Itching, or pruritus, is a typical symptom of End-Stage Kidney Disease. It can be unforgiving in severe circumstances. Although the etiology is usually benign (see xerosis), it can cause secondary problems such excoriations and lichen simplex chronicus, which can be disfiguring in severe cases. As a conservative treatment, emollients, moisturizing lotions, keratolytic agents, and hydration are frequently prescribed. Phototherapy (ultraviolet B radiation [UVB] given as total body irradiation three times a week for a total of eight to ten sessions) has been demonstrated to be effective in some circumstances. UVB (wavelength 280 to 315 nm) has been suggested to inactivate specific pruritogenic compounds and induce the synthesis of antipruritic metabolites. Malignancy is a considerable danger, particularly in fair-skinned persons. Topical capsaicin (0.025 percent) has been shown to relieve localized itch by lowering substance P levels in cutaneous type C sensory nerve terminals. Topical tacrolimus (0.03 percent for 3 weeks, then 0.01 percent for another 3 weeks) may be useful, but it is not advised as a first-line therapy or for long-term use because it can predispose to dermatologic malignancies. Gabapentin (100-300 mg after each dialysis treatment) provides antipruritic properties as well. Depression of the central nervous system is one of the most common side effects. Antipruritic characteristics are found in m-opioid receptor antagonists such as per os (PO) naltrexone. Intranasal butorphanol (a F06BF06B-opioid receptor agonist and m-opioid receptor antagonist) belongs to the same family. PO-activated charcoal, selective serotonin antagonists (ondansetron and granisetron), oral cromolyn, cholestyramine, thalidomide, erythropoietin, and intravenous lidocaine are some of the other therapy possibilities. What is Nephrology - What are some of the most common extrarenal signs of kidney disease?
Dermatologic • Musculoskeletal Symptoms and/or Arthritis • Henoch-Schönlein purpura • Cryoglobulinemia • Sarcoidosis • Amyloidosis • Multiple myeloma • Gouty nephropathy • Hemoptysis • Acute kidney damage with community-acquired pneumonia A nephropathy is a disease that affects the kidneys. Antibody against Neutrophil Cytoplasm (ANCA) -related thrombosis and vasculitides: Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis); eosinophilic granulomatosis with polyangiitis (previously known as Churg-Strauss disease); microscopic polyangiitis; and pauci-immune crescentic glomerulonephritis are all examples of granulomatosis with polyangiitis. Cryoglobulinemia • Pulmonary thromboembolism/infarction as a result of hypercoagulability (membranous nephropathy and antiphospholipid syndrome) • Volume overload (congestive heart failure, mitral stenosis) • Alport syndrome • Charcot-Marie-Tooth syndrome • HDR syndrome (hypoparathyroidism, sensorineural hearing loss, and kidney disease; also known as Barakat syndrome) • Wolfram syndrome (diabetes insipidus, diabetes mellitus, optic atrophy) • Bartter syndrome (diabetes insipidus, diabetes mellitus, optic atrophy) (type IV) Henoch-Schönlein purpura • Cryoglobulinemia • Microscopic polyangiitis • ADPKD • Abdominal discomfort Aneurysms of the cervicocranial system: • Fibromuscular dysplasia • ADPKD (also with mitral valve prolapse) What is Nephrology - What is a simple bedside diagnostic test that can detect underlying diabetic nephropathy?
Funduscopy. The association of typical microvascular problems found in people with diabetes mellitus is thought to be due to parallels in vascularization between the retina and the kidneys. Patients with type 2 diabetes with proliferative retinopathy frequently have kidney involvement, which is characterized as either microalbuminuria (in the early stages) or overt proteinuria (in the later stages). As a result, all individuals with diabetes and proliferative retinopathy should have their kidney function evaluated, including microalbuminuria tests. Although the presence of retinal suggests a diabetic source of proteinuria, the absence of diabetic retinopathy does not rule out the possibility of diabetic nephropathy. What is Nephrology - What are some of the most prevalent symptoms and indicators associated with advanced kidney disease?
In its early stages, chronic kidney disease is characterized by nonspecific signs and symptoms and can only be identified by an increase in serum creatinine. Symptoms • Appetite loss or reduction (protein aversion) • Fatigability • Fatigability • Mental changes (e.g., lethargy, stupor, inability to concentrate) • Nausea, vomiting, and dyspepsia are all symptoms of dyspepsia. • Generalized itching or pruritus • Seizures • Breathing difficulties • Edema • Intractable hiccups • A "frothy" urine appearance (typically due to proteinuria) • Erectile dysfunction (e.g., erectile dysfunction) causes a decrease in sexual interest. • Legs that are restless • Pallor • Elevated blood pressure (BP) (from anemia) • Asterixis and myoclonus (uremic encephalopathy) • Volume overload (jugular venous distention, peripheral edema, pulmonary edema, anasarca) • Friction rub (pericarditis) What is Nephrology - What are some of the familial diseases in which the kidneys play a role?6/7/2022 What is Nephrology - What are some of the familial diseases in which the kidneys play a role?
• Autosomal dominant PKD (ADPKD) is a type of autosomal dominant PKD (chromosomes 4 and 16) • Autosomal dominant PKD (ADPKD) is a type of autosomal dominant PKD (chromosomes 4 and 16) • PKD is inherited in an autosomal recessive pattern (linked to chromosome 6) • Autosomal dominant tubulointerstitial kidney disease (formerly known as familial juvenile hyperuricemic nephropathy type 1, medullary cystic kidney disease type 2, or uromodulin-associated kidney disease, connected to chromosomes 1, 16, 17, and chromosomes 1, 16, 17) • Focal segmental glomerulosclerosis (FSG) is a kind of glomerulosclerosis that affects (linked to chromosomes 1, 9, 10, 11, 19) • Fabry disease • Alport syndrome • Sickle cell nephropathy • Familial hypercalcemic hypocalciuria • Cystinuria • Hypertension • Diabetes mellitus • Fabry disease • Alport syndrome • Sickle cell nephropathy • Familial hypercalcemic hypocalciuria • HDR syndrome (hypoparathyroidism, sensorineural hearing loss, and renal disease syndrome; sometimes known as Barakat syndrome; chromosome 10p) • Liddle syndromes of apparent mineralocorticoid excess and other monogenic hypertension • Bartter and Gitelman syndromes of apparent mineralocorticoid excess and other monogenic hypertension • Nephrotic syndrome (congenital) (Finish and other variants, mapped to chromosomes 1, 3, 11, 19) What is Nephrology - Why is smoking history significant in renal disease patients?
Chronic renal disease has been linked to cardiovascular disease as well as smoking. The idea of smoking being a "independent" progression factor in renal disease has attracted researchers' interest in a number of studies. Several publications of clinical and experimental evidence on the harmful consequences of smoking on the kidneys have piqued attention since 2003, including large, prospective, population-based observational studies. These studies clearly show that smoking is a significant risk factor for renal dysfunction (i.e., an increase in serum creatinine), regardless of the underlying cause of kidney disease. It's been proposed that urine cotinine, a nicotine byproduct, could be utilized as an objective indicator of smoking exposure. Its effectiveness in people with chronic renal disease has not been studied. What is Nephrology - What important details should be gathered from the medical histories of individuals who have been referred for renal disease evaluation?
• Previous kidney disease diagnosis (e.g., documentation of BUN and serum creatinine levels) • Any asymptomatic urine problems in the past (e.g., hematuria, proteinuria) • Urinary frequency or urgency changes in the past, etc. • Urinary character or appearance changes (e.g., smell, color, frothy appearance) • Diabetes history (duration, severity, end-organ damage) • Hypertension history (including cardiac history) • Previous exposure to nephrotoxic pharmaceuticals (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], aminoglycoside antibiotics) • Adverse reactions to drugs that block the renin-angiotensin-aldosterone pathway (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists) in the past • Recent gastrointestinal endoscopic operations that necessitated bowel cleansing (risk of acute phosphate nephropathy in people who utilize phosphate-containing enema) • Recent exposure to procedures that necessitate the use of contrast (risk of contrast-induced acute kidney injury) • Recent systemic infections or co-infections • A family history of kidney disease or a relative who requires renal replacement therapy (e.g., polycystic kidney disease [PKD], Alport syndrome) • Autoimmune disease history • Any over-the-counter medications used (e.g., NSAIDs) and/or herbal, natural supplements • Any recent changes in dose of a medication or any new medication recently began |
Kembara's Health SolutionsDiscovering the world of health and medicine. Archives
June 2023
Categories
All
|