Dermatologic Disorders Associated with Chronic Renal Failure

Unusual palmoplantar blistering in the setting of hemodialysis: a case report and review of the dermatoses associated with hemodialysis

We describe a 70-year-old White female on maintenance high-flux hemodialysis for chronic renal insufficiency with an abrupt onset of asymptomatic palmoplantar blisters. The lesions were tense, noninflamed and 0.2-1.0 cm in dimension. Concomitant photo-distributed blistering of the dorsal hands and forearms was not present. A cutaneous biopsy demonstrated nonspecific histological and direct immunofluorescent findings. Serum indirect immunofluorescence and tissue cultures for bacteria, fungi and viruses were negative. Fecal porphyrins were normal but an elevated plasma uroporphyrin level of 17.0 microg/dL (normal: < 1.0 microg/dL) was observed. The duration of each hemodialysis treatment, which the patient had continued to receive three times per week, was changed from 2 to 2.5 h. Within 2 weeks no new blisters occurred. Within 6 weeks complete clinical and biochemical remission was noted. During this time course no topical steroid or antifungal therapy was employed nor was the patient's oral medication regimen altered.

Secondary cutaneous oxalosis: cutaneous deposition of calcium oxalate dihydrate after long-term hemodialysis

A 48-year-old Japanese man had miliary calcified papules on the distal fingers after long-term hemodialysis. The crystals in the dermis consisted of calcium oxalate, as revealed by light microscopy and scanning electron microscopy with energy-dispersive x-ray microanalysis. The calcium oxalate was in the form of a dihydrate crystal. Therefore a diagnosis of secondary cutaneous oxalosis was made. In cutaneous oxalosis that occurs as a result of hemodialysis, miliary deposits occur in the fingers, but not the toes, and are present more frequently on the palmar aspects of the fingers. This localization may result from local differences in the metabolism or concentration of calcium or oxalate, or changes in the blood circulation.