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Diagnosing chronic kidney disease through the skin

By DR. GRACE CAROLE BELTRAN, The Philippine STAR Published Mar 12, 2024 5:00 am

CT, a 48-year-old male, contracted severe COVID three years ago. Upon discharge, he was unable to walk and required full assistance with bed activities, hygiene and feeding. Prior to COVID, he was a healthy, athletic person with no serious health conditions. There was one episode of bloody urine. A consult done with a urologist was inconclusive. It finally stopped even without intervention and has not recurred since then. After a six-month recovery period from COVID, his condition was unremarkable—he was getting better by the day.

Two years later, CT was hospitalized again. This second illness really took a toll on his kidneys to the point that his nephrologist recommended dialysis three times a week (kidney function was estimated to be at eight to 12 percent of normal), a regimen CT has been following since February 2023. Nurses at the dialysis center often remarked on his slate-gray complexion, very typical of chronic kidney disease (CKD) patients.

In the months following his dialysis, CT noticed edema on both legs, gradual formation, and enlargement of a dark spot on the top of both his feet, and generalized itching, particularly in his back area. Additionally, he observed that he was developing dry, scaly, and lackluster skin and his feet and nails started fissuring, changing to a whitish hue.

More than 37 million American adults and seven million Filipinos are suffering from chronic kidney disease with one Filipino every hour getting the disease.

More than 37 million American adults and seven million Filipinos are suffering from chronic kidney disease with one Filipino every hour getting the disease.

In Asia alone, Filipinos comprise about 25% of the 840 million as of 2021.

What you need to know about CKD

Our kidneys are each the size of a computer mouse. They filter all the blood in our body every 30 minutes, working hard to remove wastes, toxins, and excess fluid. They also help control blood pressure, stimulate production of red blood cells, keep our bones healthy, and regulate blood chemicals that are essential to life.

CKD develops when the kidneys have become damaged over time (for at least three months) and have a hard time doing all their important jobs. As such, the kidneys cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems such as heart disease and stroke.

Developing CKD usually is a very slow process with very few symptoms at first. It usually gets worse over time though treatment has been shown to slow progression. If left untreated, CKD can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or a kidney transplant is needed for survival.

If you have kidney disease, you won’t see early warning signs on your skin at first. However, as the disease progresses, you may develop one or more of the following:

Skin can become so dry that it is rough and scaly, feels tight, cracks easily and develops fish-like scales. Extremely dry skin is common in people who have end-stage kidney disease, which requires dialysis or a kidney transplant.

Severe itching becomes a silent struggle in the journey of chronic kidney disease.

Extremely itchy skin is a common symptom of advanced kidney disease. The itch can range from irritating to life-disrupting. You can develop raw, bleeding skin or sores, thick, leathery skin (lichen simplex chronicus), and firm, itchy bumps (prurigo nodularis).

Skin color changes. When the kidneys stop working as they should, toxins build up in your body. This buildup can cause color changes in the skin such as an unhealthy paleness or darkness, a gray or yellowish hue, thick skin with bumps and deep lines, cysts and spots that look like whiteheads. The last two develop when you’ve had itchy skin for a long time and scratch often.

Nail changes. Kidney disease can affect the appearance of your fingernails, toenails, or both. People who have advanced kidney disease can develop a white color on the upper part of one or more nails, and a normal to reddish-brown color below; pale nails, and white bands running across one or more nails.

A person with kidney problems could experience nail changes, such as a white color on the upper part and normal to reddish-brown color below, pale nails, and white bands.

Swelling (manas).Your kidneys remove extra fluids and salt from your body. When they can no longer do this, the fluids and salt build up in your body. This buildup causes swelling, which you may notice in your legs, ankles, feet, hands and face.

A patient with kidney disease could experience swelling in various body parts due to the inability of kidneys to remove excess fluids and salt.

Skin rash. When the kidneys cannot remove waste from your body, a rash can develop. One rash that occurs in people who have end-stage kidney disease causes small, dome-shaped, and extremely itchy bumps. As these bumps clear, new ones can form. Sometimes, the small bumps join together to form rough, raised skin areas.

Blisters can also form on the patient’s hands, face and feet. The blisters will open, dry up, and crust over. As they clear, scars appear.

A lump in your belly. This can be a sign of kidney cancer. In its early stages, kidney cancer seldom causes symptoms. When the cancer advances, it can cause a mass or lump in the belly and lower back. If you find any spot or lump, see your doctor.

Calcium deposits under the skin. Your kidneys have several jobs. One is to balance certain minerals in your blood like sodium and phosphate. When the kidneys cannot maintain a healthy balance, levels can rise. Some people develop deposits of calcium under their skin, usually around a joint and are not painful. However, when they develop in your fingertips, they can cause a great deal of pain. If one of these deposits pushes up through the skin, you may see a chalky secretion.