الفهرس | Only 14 pages are availabe for public view |
Abstract The skin mirrors the individual’s wellbeing ,visible for both the patient and the physician. It can be a source of information for the diagnosis of multi-system diseases and diseases of internal organ as symptoms and signs in the skin and mucous membranes can be supportive of the diagnosis of internal disease or even be a part of the initial presentation. End stage renal disease is CKD which has progressed so far that the patient’s kidneys no longer function sufficiently and dialysis or transplantation become necessary to maintain life. Diabetes mellitus, hypertension, smoking, cardiovascular disease, and chronic use of NSAIDs were the high risk factors of developing CKD. Most people with ESRD eventually die from complications of CVD or from infection, if dialysis is not provided. Dialysis treatment replaces some of the renal functions through diffusion (waste removal) and ultrafiltration (fluid removal) but it is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. So dialysis is regarded as a solution until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate. About 50-100% patients with ESRD have at least one associated skin manifestations. The dermatologic findings can precede or follow the initiation of HD treatment and there are more chances to develop newer skin changes with increased the life expectancy of CRF patients. These skin manifestations are sometimes related to the underlying cause of renal illness but are more frequently directly Summary 83 or indirectly associated with renal failure with an almost 100% prevalence in dialysis populations. Skin manifestations have a considerable negative effect on patient’s quality of life. They can induce serious discomfort, anxiety, depression and sleeping disorders and have an overall negative effect on mental and physical health. Although the majority of dermatological disorders in CKD are relatively benign, a few rare skin diseases have the potential to cause serious morbidity and mortality as NSF. The aim of this work was to assess the pattern of the skin, nail, hair and mucosal disorders among patients with ESRD on HD and to evaluate the potential relationship between the skin, nail, hair and mucosal disorders and etiology of CRF, their percentage according to the duration of HD and their relations with laboratory parameters in these patients. Two hundred patients of ESRD on regular HD, 132 males and 68 females and aged from 15y – 65 years, were selected and subjected to full history and dermatological examinations including skin, hair, nails and oral mucosa. Kidney function tests (blood urea and serum creatinine) were done for every patient. Results of this study showed that the most frequent cutaneous finding in patients with CRF on HD was xerosis (72%), followed by pruritus (52%) then cutaneous hyperpigmentation (44%). The commonest nail changes included absent lunula (61%), half and half nail (41%) and koilonychia (29%). Hair changes were sparse scalp hair (48%), sparse body hair (41%) and brittle and lusterless hair (39%). Xerostomia (46%) and Summary 84 macroglossia with teeth markings (43%) were the most common oral changes in those patients. According to the duration of hemodialysis, patients were classified into two groups; group I with duration of dialysis ranging from 6 months to 8 years and group II with duration of dialysis ranging from 8 t o 16 years. The larger numbers of patients complaining of cutaneous, nail, hair and mucosal manifestations were present in patients of group I. This may be related to variable associated conditions as smoking, diabetes mellitus, hypertension, hepatitis C virus infection or schistosomiasis. There was variable correlation between blood urea level and the highly reported cutaneous, nail, hair and mucosal changes. A significant correlation was reported in sparse body hair, xerostomia and macroglossia with teeth markings. However there was no correlation between serum creatinine level and the highest incidence of cutaneous, nail, hair and mucosal changes. |