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Dr. Frush - End stage Renal Disease
Dr. Frush's lecture on ESRD
13
Medical
Professional
11/27/2012

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Cards

Term
Leading cause of ESRD
Definition
Diabetes
Term
Complications of Renal disease
Definition
PAD
Neuropathy
Derm disorders
Psychosocial issues
Term
Derm manifestations of ESRD
Definition
Acquired perforating dermatosis
Porphyria cutanea tarda
Calcinosis cutis
Calciphylaxis
Nephrogenic systemic fibrosis
Uremic pruritis
Foot ulcer
Term
Acquired perforating dermatosis
Definition
characterized by transdermal elimination of material from dermis
Scattered cone shaped and plugged keratotic papules, plaques and nodules
Located in high friction areas - lower extremities most common
Lesions pink in fair skin, brown in darker skin
Term
Acquired perforating dermatosis - Treatment
Definition
Potent corticosteroids
Topical or oral retinoids
Vitamin A
Keratolytics
UVB light therapy
Term
Porphyria Cutanea Tarda
Definition
Disorder of heme biosynthesis
Vesicles erupt in sun exposed areas
Not as common now bc iron overload in dialysis not as prevalent
Term
Porphyria Cutanea Tarda - treatment
Definition
Manage iron overload
Minimize sun exposure
Minimize any photosynthesizing medication
Term
Calcinosis Cutis
Definition
Firm papules, plaques or nodules
Occasionally can exude white chalky substance
Found near joints or on fingertips
Treatment is management of calcium and phosphorus levels
Term
Calciphylaxis
Definition
Exact etiology unknown
Rare but can be fatal
High incidence in dialysis pts, hyperparathyroid pts and combined pts
Calcification and obstruction of small and medium cutaneous vessels
Hyperplasia of tunica media and tunica intima
Septal and/or lobular subcutaneous necrosis
All this leads to distal ischemia, painful ulcers and possible amputation
Term
Calciphylaxis - treatment
Definition
Debridement and local wound care
Fibrinolytics
Hypophosphatemic diet
Calcitriol supplementation
Pain management - don't want to use NSAIDs due to kidney function and corticosteroids may make it worse
Term
Nephrogenic Systemic Fibrosis
Definition
Seen in pts with ESRD with exposure to gadolinium (found in contrast)
usually see symptoms 2-4 weeks after exposure
Starts in LE first but moves to UE and trunk - spares the head
Bilateral fibrotic or brawny induration of the skin
Thickened indurated erythematous raised skin lesions
can lead to permanent contractions
Peau de orange appearance
Term
Uremic Pruritus
Definition
Severe itching of the skin
Pathophysiology unclear
Excessive scratching leads to breaks in skin which may lead to infection
Nalfurafine and Naltrexone can be helpful to reduce itching
Term
Internation Working Group on the Diabetic Foot (IWGDF) Classification
Definition
Used to assign risk for foot problems
Risk 0 - no recognizable risk factor
Risk 1 - neuropathy with no other risk factor
Risk 2 - PAD with or without neuropathy
Risk 3 - Current foot ulcer, Hx of foot ulcer or prior amputation
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