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Is itching common in kidney diseases?
What is importance of itching in kidney diseases?
Pruritus or itching is among the most common symptom of ESKD. In severe cases, it can be unrelenting. Although mostly benign in etiology (see xerosis, previous), it can lead to secondary complications, such as excoriations and lichen simplex chronicus, which may be disfiguring in extreme cases.
The use of emollients, moisturizing lotions, keratolytic agents, and hydration have been commonly recommended as conservative treatment.
In some cases, phototherapy (ultraviolet B radiation [UVB] administered as total body irradiation 3 times a week for a total of 8 to 10 sessions) has been shown to be helpful. It has been suggested that UVB (wavelength 280 to 315 nm) inactivates certain pruritogenic chemicals and induces the formation of metabolites with antipruritic effects.
The risk of malignancy is fairly significant, especially in fair-skinned individuals.
How is itching treated in kidney diseases?
Topical capsaicin (0.025%), by reducing the levels of substance P in cutaneous type C sensory nerve endings, has been useful for localized pruritus.
Topical tacrolimus (0.03% for 3 weeks, followed by 0.01% for another 3 weeks) may be beneficial but can predispose to dermatologic malignancies, so it is not recommended as a first line therapy or for prolonged use.
Gabapentin (100 to 300 mg after each dialysis treatment) also has antipruritic effects. Prominent side effects include depression of the central nervous system.
μ-opioid receptor antagonists, such as per os (PO) naltrexone, has antipruritic properties. In the same family, intranasal butorphanol (a F06BF06B-opioid receptor agonist and μ-opioid receptor antagonist) is another option.
Other treatment options include PO-activated charcoal, selective serotonin antagonists (ondansetron and granisetron), oral cromolyn, cholestyramine, thalidomide, erythropoietin, and intravenous lidocaine.
