الفهرس 
IntroductionOnly 14 pages are availabe for public view
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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
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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
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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.