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Uremic Pruritus


Presentation

  • The present case report describes dermatopathic lymphadenopathy as a harmless cause of enlarged lymph nodes in uremic pruritus for the first time.[ncbi.nlm.nih.gov]
  • We present two patients with uremic pruritus and acquired perforating dermatosis who were successfully treated with amitriptyline.[ncbi.nlm.nih.gov]
  • Pruritus was present in 145 (50.2%) of the haemodialysis patients and 32 (61.5%) of the CAPD patients. Men, patients with liver disease, and patients with pruritus before starting dialysis treatment were more likely to have uremic pruritus.[ncbi.nlm.nih.gov]
  • METHODS: We conducted a retrospective review of consecutive patients who presented to the renal palliative care clinic in a single institution with pruritus refractory to antihistamines between April 2011 and September 2012.[ncbi.nlm.nih.gov]
  • An additional 36.1% of patients reported pruritus to have been present in the past during the renal disease period.[ncbi.nlm.nih.gov]
Rigor
  • Unfortunately, most of these therapies have not been subjected to rigorous clinical trials and clinical success has been variable.[ncbi.nlm.nih.gov]
  • The current evidence is insufficient to show that acupuncture is an effective treatment for UP inpatients with ESRD because of suboptimal quality and lack of methodological rigor of included studies.[ncbi.nlm.nih.gov]
  • Large, simple, rigorous, multiarm RCTs of promising therapies are urgently needed. Copyright 2017 The Authors. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Treatments currently used for uremic pruritus such as antihistamines, steroids, emollients, and phototherapy (UVB) have not been investigated rigorously, and no drugs have been approved for this indication by the U.S. Food and Drug Administration.[cjasn.asnjournals.org]
Intravenous Drugs
  • Alternative therapeutic approaches, including topical, oral, and intravenous drugs; dialysis modifications; homeopathic therapies; and physical treatments have been used, but few evidence-based studies exist to support their utility.[ncbi.nlm.nih.gov]
Inguinal Lymphadenopathy
  • PATIENT: A 43-year-old male patient was admitted to our hospital with inguinal lymphadenopathy and pruritus. He turned out to be uremic due to focal segmental glomerulosclerosis (creatinine 4.5 mg/dl, MDRD creatinine clearance 12 ml/min).[ncbi.nlm.nih.gov]
Chronic Cough
  • We are currently developing nalbuphine ER for the treatment of chronic pruritus, chronic cough in patients with idiopathic pulmonary fibrosis (IPF) and levodopa-induced dyskinesia (LID) in patients with Parkinson’s disease.[trevitherapeutics.com]

Workup

  • Those with a negative workup for GP fall into idiopathic pruritus (IP). In those over the age of 65, this form of idiopathic itch is often dubbed senile pruritus or Willan’s itch as it is often associated with dry skin [ 2 ].[omicsonline.org]

Treatment

  • RESULTS: 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments.[ncbi.nlm.nih.gov]
  • Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.[ncbi.nlm.nih.gov]
  • None of the patients was forced to drop out of the study due to side effects of the treatment. Our study suggests that gabapentin is a safe and effective treatment for uremic itch.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To evaluate the efficacy of gabapentin for the treatment of uremic pruritus (UP).[ncbi.nlm.nih.gov]
  • Abstract Uremic pruritus and its treatment are reviewed.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of patients with severe pruritus was significantly worse than the others.[ncbi.nlm.nih.gov]
  • Abstract Pruritus is a common and bothersome problem among uremic patients which negatively affects life quality and prognosis of the patient. Various factors are known to be involved in the development of pruritus.[ncbi.nlm.nih.gov]
  • From these data, it is clear that patients who suffer from pruritus also have a lower HR-QOL including sleep disturbances which may lead to poor prognosis. 4. Treatment for CKD-associated pruritus 4.1.[intechopen.com]

Etiology

  • However, its etiology remains unclear. In an attempt to clarify its cause we tried to correlate pruritus and its intensity with several serological variables in 94 hemodialysis patients.[ncbi.nlm.nih.gov]
  • Several hypotheses have been postulated for the possible underlying etiology, but none is conclusive.[ncbi.nlm.nih.gov]
  • During the last decades a big number of substances were considered to be etiologic factors of UP, and an even bigger number of therapeutic substances appeared with promising potentials and conflicting results in the course of their use.[ncbi.nlm.nih.gov]
  • Abstract As one of the most troublesome complications in patients with chronic renal disease, the etiology of uremic pruritus remains unknown, and the current therapeutic approaches are limited and unsatisfactory.[ncbi.nlm.nih.gov]
  • Its etiology is not fully understood and that is why there is no specific treatment. The endocannabinoid system plays a role in many pathological conditions. There is reliable evidence on the association between cannabinoid system and pruritus.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Epidemiology of peritoneal dialysis: a story of believers and nonbelievers. Nat Rev Nephrol 2010; 6:75–82. 48. Griva K, Li ZH, Lai AY, et al.[journals.lww.com]
  • Hayani K, Weiss M, Weisshaar E (2015) Clinical findings and provision of care in Haemodialysis patients with chronic itch: new results from the german epidemiological haemodialysis itch study. Acta Derm Venereol 96:361 CrossRef Google Scholar 21.[link.springer.com]
  • En el presente trabajo se realiza una revision de los posibles mecanismos en la etiologia del prurito uremico Epidemiology and historical bibliography comparative dermatology anatomy and organization of human skin functions of the skin diagnosis of skin[scinapse.io]
  • Mistik S, Utas S, Ferahbas A, Tokgoz B, Unsal G, et al. (2006) An epidemiology study of patients with uremic pruritus. J Eur Acad Dermatol Venereol 20: 672–678. View Article Google Scholar[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Little is known about the pathophysiology of UP, and there is currently no consensus or evidence-based 22 treatments for UP.[ncbi.nlm.nih.gov]
  • The pathophysiology of uremic pruritus is poorly understood but believed to result from metabolic disequilibrium, increased release of pruritogenic mediators and altered balance between the opioid receptors.[ncbi.nlm.nih.gov]
  • Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Although enough is known to determine a reasonable set of steps in approaching a patient's uremic pruritus, more research is needed to understand the pathophysiology of this condition and to establish more reliable treatments.[ncbi.nlm.nih.gov]
  • CONCLUSION: IL-31 may play an important role in the pathophysiology of uremic pruritus. Copyright 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]

Prevention

  • Abstract Skin care is very important for preventing uremic pruritus. However, mild uremic pruritus has usually been treated with antihistamine and urea-containing ointments.[ncbi.nlm.nih.gov]
  • By preventing or reducing uremic pruritus, baby oil treatment may also improve quality of life in this patient group. 2011 Blackwell Publishing Ltd.[ncbi.nlm.nih.gov]
  • […] hemodialysis 1346 A demographic overview 1358 Michael J Lysaght Ph D University of Tehran 1366 Registry report of dialysis therapy in Japan 1376 Structure and outcome measurements EDTAERA registry 1388 Outcomes critical overview Australian registry 1398 Prevention[books.google.com]
  • Relieving or preventing itching. 2. An agent that relieves or prevents itching. Despite about a century of research, no single effective antipruritic treatment exists Several topical and orally administered agents can help suppress itching.[wordinfo.info]
  • Activated charcoal is thought to prevent the absorption of an unknown pruritogen. Cholestyramine is not as effective and is associated with adverse effects, such as acidosis. Efficient dialysis is helpful.[emedicine.medscape.com]

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