Cutaneous manifestations of chronic renal failure in children with emphasis on pruritus in Assiut-upper Egypt

One hundred percent of adult patients with chronic renal failure [CRF] develop cutaneous findings as a result of uremia or therapeutic intervention. The incidence of pediatric end stage renal disease [ESRD] is increasing and the life expectancy is also on rise. Despite this, only few studies have assessed cutaneous manifestations of CRF in children. Pruritus is a frequent feature found in uremic patients, and several causes have been implicated in its pathogenesis. The aim of the present work is to define the occurrence of renal failure related skin diseases in children with CRF undergoing hemodialysis with emphasis on pruritus. Also, to evaluate whether uremic pruritus is correlated to clinical data and serum levels of various endogenous substances including parathormone, vitamin A and histamine. Thirty eight children with CRF undergoing hemodialysis were included. Each patient underwent complete history taking and thorough clinical and dermatological examinations. Severity of pruritus was determined. All patients were subjected to measurement of serum calcium, phosphate, parathormone, vitamin A and histamine. In addition to serum creatinine, blood urea, albumin and hemoglobin. The result proved that the overall skin disorders were 97.6%. Xerosis was the commonest one [71.11%] followed by pruritus [52.6%], pallor [52%], sallow yellowish discoloration in 36.8%, ecchymosis [36.8%], ichthyosis [26.3%] and others. Pruritic patients were classified as mild in 45% and moderate to severe in 55% of cases. There was no relation between the presence and severity of pruritus and age, sex, duration of dialysis, xerosis and hematological and biochemical parameters except for serum histamine. However, serum levels of histamine did not correlate with severity of pruritus

---

Conclusion: Uremia related cutaneous manifestations were common in children undergoing hemodialysis. Serum histamine may have a potential role in the appearance of uremic pruritus in children. However, additional studies in larger scale are needed to clarify the role of histamine in the pathogenesis of pruritus