9: Podiatric Manifestations in End Stage Renal Disease - Frush Flashcards
leading cause ESRD
diabetes (45%)
___ of diabetic pts will develop ulcer during lifetime
25%
4 complications of renal disease
PAD
neuropathy
derm disorders
psychosocial issues
15% of pts with ESRD have PAD why?
as renal function decreases, phosphate levels increase (calcium and phosphorus deposit in the vascular bed leading to calcified vessels)
ESRD is also linked to hyperparathyroidism
High CRP contributes to PAD (dialysis pts shown to have high CRP)
______ of hemodialysis pts have neuropathy
50-60%
- uremia on its own can cause neuropathy
autonomic neuropahty in 45-60%
characteristics of autonomic neuropathy
- postural hypotension
- shunting of cutaneous capillary beds
- atrophy of sebaceous and sweat glands
how is uremia a cause of immune dysfunction?
- impairs polymorphonuclear cells (impaired resistance to bacteria)
- impaired T cell function
describe acquired perforating dermatosis
- transdermal -elimination of material from dermis
- scattered cone shaped and plugged keratotic papules, plaques and nodules
- located in high friction areas
- lesions pink in fair skin, brown in darker skin
tx acquired perforating dermatosis
potent corticosteroids topical or oral retinoids vit A keratolytics UVB light therapy
describe porphyria cutanea tarda
- disorder of heme biosythesis
- vesicles erupt in sun exposed areas
tx porphyria cutanea tarda
- manage iron overload
- minimize sun and photosensitizing medication
describe calcinosis cutis
- firm papules, plaques or nodules
- occasionally can exude white chalky substance
- near joint or on fingertips
- manage calcium and phosphorus for tx
describe calciphylaxis
- get calcification and obstruction of small and medium cutaneous vessels
- hyperplasia of tunica media and tunica intima
- septal and/or lobular subcutaneous necrosis
–> distal ischemia, painful ulcers and possible amputation (often fatal)
tx calciphylaxis
debridement and local wound care with fibrinolytics
hypophosphatemic diet
calcitriol supplementation
pain management
what would you use for pain management for calciphylaxis?
NOT NSAIDS (kidney function)
corticosteroids may make calciphylaxis worse
seen in pts with ESRD with exposure to gadolinium
nephrogenic systemic fibrosis
symptoms 2-4 wks after exposure
describe nephrogenic systemic fibrosis
- starts first in LE - can move to UE and trunk but spares ehad
- bilateral fibrotic or brawny induration of skin
- thickened, indurated erythematous raised skin lesions
- peau de orange appearance
- can lead to permanent contractions
severe itching of the skin
uremic pruritus
immunohypothesis and opioid hypothesis as possible pathophysiology
tx itching of uremic pruritus
nalfurafine and naltrexone
those with _____ had highest incidence of ulcer and LEA
both DM and ESRD
is dialysis itself a risk factor for foot ulcers?
prevalence of foot ulcers was 5 times higher in dialysis group
LE complications 2 times higher in dialysis group
why dialysis risk factor for foot ulcers?
- during dialysis there is reduction in skin microcirculation and tissue oxygenation
- constant change in fluid volume in the tissues
- less likely to inspect feet and go to podiatry visits
______ of hemodialysis pts suffer from depression
20-30%
leads to decrease in care (less self monitoriing, missed appts, compliance)
needed for keratinocyte migration and protects against apoptosis
zinc
also need albumin for wound healing
there is a suggested reading article
look at it maybe
