Kidney Disease: Types of Skin Lesions

What are the symptoms of poor kidney function?

The kidneys are a pair of organs located below the abdomen, on either side of the spine. They are responsible for blood filtration, removing contents to be excreted via urination.

Kidney function may be affected for several reasons: pre-existing acute or chronic diseases; environmental factors, including exposure to pollutants; certain medications and toxins; water intake; blood flow; and kidney injury. Other factors, such as diet, nutrition, exercise, smoking, alcohol consumption, and obesity, can increase the risk of developing kidney disease. 

When the kidneys malfunction, it can cause an excess build-up of toxins, leading to kidney failure. Kidney failure is marked by changes inside the body that may include blockages, reduced oxygen transport, inflammation, alterations to the shape and size of the kidney, bleeding, and impaired blood flow. 

These can manifest into various physical symptoms outlined by the CDC¹ and the NHS.²

• Decreased urine output
• Dizziness
• Foamy or bubbly urine
• Swelling or oedema in the lower extremities (legs, ankles, feet) as an outcome of fluid build-up
• Shortness of breath (idiopathic, or of unknown origin)
• Fatigue
• Persistent nausea
• Seizures
• Metallic taste in the mouth
• Ammonia breath 
• Pain
• Confusion
• Decreased appetite 
• Puffy eyes 
• Muscle cramps
• Blood in the urine
• Insomnia or trouble sleeping
• Erectile dysfunction
• Itchy skin
• Weight loss
• Increased need for urination 
• Chills or feeling cold when others feel warm
• Fever 

What are the signs that your kidneys are not working properly?

When the kidneys malfunction, you can spot signs indicating the incidence of kidney disease. The symptoms can change based on the progression of the disease, and can also be subjective. 

Some of the early signs can include:

• Decreased output of urine than usual
• Swelling of the limbs (oedema, caused by a build-up of fluids)
• Shortness of breath
• Dark coloured urine (usually due to dehydration)
• Blood in the urine
• Foam or bubbles in urine (indicating the presence of proteins)

How does kidney failure affect the skin?

Kidney failure can affect the skin due to an imbalance of fluids in the body and the consequent problems faced during the transport of nutrients. Research shows that certain skin manifestations are consistent with kidney disease, outlined below:³

1. Extremely dry skin: This can cause the skin to crack, feel tight, become rough, and have a scaly fish-like appearance.
2. Itchy skin: It is most commonly seen in those with late-stage kidney disease, a time when the patient requires transplant or dialysis. Itching can be localised or spread across the body. Frequent scratching can cause bleeding and increased wound exposure.
3. Lichen simplex chronicus: The skin has a leather-like appearance and is thick.
4. Nodularis prugio: The skin feels firm and has very itchy bumps. Cysts and spots can also occur, appearing like whiteheads.
5. Skin colour: The skin can change colour due to the build-up of toxins. It can turn pale, yellowish, or it can darken.
6. Nail alterations: Nails can appear pale or have white bands across them.
7. Blisters: Blisters can appear on your hands, legs, or face. They can also open up, causing them to become crusty and potentially leading to scarring. 

Can kidney failure cause lesions?

A skin lesion refers to an area of the skin with an abnormal growth or appearance compared to other skin regions. The skin can develop rashes⁴ during kidney disease. These can cause itching episodes that can increase in severity during the night and can be felt across the abdomen, back, head, and/or hands. 

• It could be felt in a single area or spread across various areas. 
• Continuous itching can further lead to sores and redness. This can also cause bleeding and/or scarring. 
• Skin abnormalities can also be present as boils, blisters, scaling, and spots.

Itching and CKD (Chronic Kidney Disease)

How common is itching?

Itching is a common symptom of end-stage renal disease or progressive/severe kidney disease. 

Kidneys are responsible for fluid balance regulation within the body, vital for transporting nutrients to the cells. This is important to ensure overall health. During kidney malfunction, this process of regulating the fluid balance is impaired, causing a build-up of toxins as the kidneys cannot excrete toxic materials. This, therefore, causes itching, primarily seen in late-stage or advanced kidney disease. 

Research shows that pruritus (itchy skin) is extremely common during advanced and severe conditions of kidney malfunction, observed in patients across the world.⁵ Additionally, research supports the statistic that 50% of the individuals on dialysis will potentially experience itchy skin.⁶ Another study also revealed that this type of itching post-dialysis has a higher prevalence in people assigned male at birth (AMAB) than those assigned female (AFAB) at birth.⁷ Research has also highlighted that some individuals with stage 3 kidney disease (advanced but not as severe as end-stage renal disease, or ESRD) may experience itching.⁸ 

What are the symptoms of itching in kidney disease?

Uraemic pruritus (UP) is the scientific name for skin itching. It is a sign of end-stage renal disease (ESRD), common in individuals with chronic kidney disease (CKD). 

Pruritus experienced during this time is:

• Progressive, i.e. it increases over time
• Continuous or periodic
• Localised to a single area or spread across the body, including the head, arms, and legs
• Can be experienced with other symptoms, such as changes in skin colour, skin pigmentation or hyperpigmentation, tight skin, rough skin, scaly appearance to the skin, itchy skin, blisters, cysts, spots, nail alterations, blisters, and/or leather-like texture of the skin

Itching during kidney disease is caused by issues that arise within the body due to the impairment of regulatory activities that are vital for proper renal function. These include, but are not limited to, elevated levels of phosphorus, inflammation, an increase in histamines, allergens, irritants, pollutants, neurological problems, dehydration, dry skin, excess urea (uremia), insufficient dialysis, and other pre-existing conditions.  

How will it affect me?

Itching in your skin can irritate and affect individuals differently. Itching can be an urge that might be difficult to resist due to the discomfort caused by it. However, it is important to remember that itching can lead to scratches and bleeding, leaving the skin exposed and increasing the possibility of infections.

However, it must be stressed that itching, coupled with other relevant symptoms, indicates that your kidneys are malfunctioning at an advanced stage and require immediate care. 

Sometimes individuals may seek medical help to treat the skin symptoms in cases where other symptoms are not apparent. Seek a complete diagnosis involving blood and urine tests from your medical practitioner. 

Treatment options

Uremic pruritus treatment options are subjective and greatly vary from person to person based on severity, occurrence, stage of kidney disease, environmental factors, accessibility, efficacy,  pre-existing allergies, and other health conditions. 

However, research has shown the efficacy of some treatment options, outlined below:⁵ 

Topical treatment

Visiting a dermatologist is vital to diagnose any primary skin conditions. Additionally, they may prescribe certain medicated moisturisers and other skincare products. Research shows that menthol or pramoxine are particularly beneficial in treating pruritus.⁹ A study revealed that using essential oils can significantly increase hydration, thus reducing the severity of symptoms.⁶

Pharmacological therapy

Your medical practitioner may suggest medicines to tackle itching during kidney disease. Commonly prescribed medicines include gabapentin and pregabalin. Research supports that 100mg - 300mg doses of gabapentin can reduce itchiness in patients with end-stage renal failure. Pregabalin is a substitute administered in doses of 25 mg - 75 mg for patients intolerant to gabapentin.⁵

Nutrition

Nutrition plays an important role in tackling these symptoms. It is a supplemental therapy to reduce itchiness and inflammation, as well as maintain fluid and mineral balance. 

To control the severity of inflammation, the diet should be balanced, with an emphasis on anti-inflammatory food items. Research shows that fruits, vegetables, antioxidant-rich foods, legumes, and nuts should be included in the diet to battle inflammation in chronic kidney disease.⁹ Additionally, a high protein intake from plant-based sources such as soy, tofu, and pea protein is beneficial in reducing itches caused by inflammation. 

It is also vital to reduce the intake of dairy, red meat, high-calorie food, spicy food, and high-sugar-content foods. It might be worth consulting a renal dietitian for a balanced nutrition plan, especially if you have end-stage renal disease.

Inflammation reduction 

Inflammation can increase itching severity. Therefore, triggers and irritants such as dyes, chemicals, fragrances, perfumes, laundry detergents, lotions, soaps, face/body washes, and pollutants should be approached with caution. Additionally, heat and hot water can increase the itching sensation due to the temperature of your surroundings - for example, at night and during your bath.

Hydration

Hydration is a main part of tackling the itching caused by kidney disease. Those undergoing dialysis treatments for kidney disease, in particular, should increase their water intake after discussion with a renal dietician. 

Non-pharmacological therapies

Phototherapy using UVB (ultraviolet-B) light is beneficial in treating excessive, severe itching in patients with kidney disease. It works by terminating the spread of components that contribute to itching. Research provides evidence of its efficacy; however, it is associated with the risk of immunosuppression and should be considered only after discussion with your practitioner. Broadband UVB (BB-UVB) is the most beneficial, with considerably long-lasting effects.¹⁰

Acupuncture is another effective tool in treating itching. It is not a common technique used in western medicine; however, there are benefits to the treatment. Research shows that acupuncture can potentially relieve itching by blocking certain fibre impulses. It is most beneficial as an adjunct, or supplementary, treatment rather than the sole treatment for uremic pruritus.¹¹ 

FAQs

What does skin look like with kidney disease?

The skin may have a grey or yellowish pallor. Certain areas of the skin could also be darkened, in addition to a potential unhealthy pale tone. If you have itchy skin, this can cause skin thickening with cysts and/or bumps. This is due to a buildup of toxins, a common feature of all kidney-related disorders due to the impaired kidney function of toxin excretion in its diseased state.

Is dry skin a symptom of kidney problems?

Dry skin causes the skin to be itchy, which is a common symptom of kidney disorders due to the imbalance of fluids and impaired transport of nutrients and necessary minerals to target sites within the body, such as the cells. 

Does kidney disease cause skin lesions?

It is possible to develop skin lesions as a complication of kidney disease and/or associated therapy.

Do kidney disease symptoms vary on the basis of gender?

People AMAB and AFAB  experience similar symptoms of kidney disease as well as progression. However, people AFAB have a higher risk of developing urinary tract infections compared to people AMAB. People AMAB, on the other hand, have a higher risk of progressing to end-stage renal disease faster than people AFAB.