الفهرس 
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Abstract
SUMMARY
C
hronic kidney disease (CKD), regardless of its cause, may be accompanied by various skin lesions. The most common symptom in children suffering from CKD is pruritus however other signs that may be seen are xerosis, skin hyperpigmentation, ecchymoses, acquired perforating dermatoses, nail lesions, calcinosis cutis, as well as eczematous lesions at the site of an arteriovenous fistula and skin infections.
Data on different skin lesions in children with CKD is very limited; only few reports have been published discussing xerosis in pediatric patients and most studies were conducted on a small number of patients who needed renal replacement therapy.
This study aimed primarily to screen the different dermatological manifestations in pediatric patients with CKD, in addition to studying the relationship of dermatological manifestations with the CKD stage, types of dialysis, and various clinical and metabolic parameters.
This was a cross sectional study, that was conducted at Pediatric Dialysis and Nephrology unit, Children’s Hospital, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt, during the period from February 2023 to August 2023. 70 patients were enrolled in our study being divided into two groups; group 1 including CKD patients stages (2-4) and group 2 including CKD patients with stage 5 on regular hemodialysis.
In our study, xerosis was considered the most frequent dermatological manifestation (78.6%) following it pruritus (62.9%) then pallor (35.7%), hyperpigmentation (20%), hypertrichosis (10 %), nail and hair abnormalities (8.5%)and post inflammatory hyperpigmentation (4.3%).
Our study focused on the fact that pruritus was prevalent among CKD patients and that there was no correlation between its incidence and clinico-demographic or dialysis data in form of: CKD stage, CKD duration and primary cause, dialysis type, dialysis duration and dialysis efficacy. Neither blood transfusions nor frequently taken medications (antihypertensives, calcium, phosphate binders, ESA) had affected the prevalence of pruritus. No significant specific lab results were associated with pruritus except for haemoglobin level which was slightly high in pruritic patients.
Our study showed that prevalence of xerosis was not affected by clinico-demographic or dialysis data: CKD stage, duration, presence of dialysis or not, type and duration of dialysis, the only significant relation was between efficacy of dialysis and incidence of xerosis as it was noticed that higher efficacy rates were associated with low incidence rates of xerosis, this may be attributed to the fact that better dialysis efficacy contribute to better removal of uremic toxins that may lead to xerosis. High TLC (total leucocytic count) was noticed in xerotic patients, this can be explained that xerosis & impaired skin barrier in children with CKD pose a risk for different cutaneous infections & inflammation which may cause elevation of neutrophilic count and subsequently TLC.
Unfortunately, there are no reports in literature regarding the relation between need to blood transfusion and pruritus and xerosis in CKD patients. In our study there was no significant association between both variables, this can be explained by the fact that blood transfusion follow strict precautions and good screening programs including proper matching that prevents any complication that might occur to the patient, also it reflects the high step improvement in anemia management strategies.
Our recommendations: routine regular dermatological examination for CKD children for early detection and prevention of further complications, more diagnostic tests are needed for better assessment and correlation of cutaneous manifestations with systemic diseases and that further multi-center studies are needed to detect various skin manifestations in CKD patients with different CKD stages and correlate it with the used dialysis modalities.