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Hautmanifestationen bei Nierenerkrankungen

Cutaneous manifestations in renal diseases

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Zusammenfassung

Neben allgemeinen Hautveränderungen wie Blässe oder Trockenheit und dem häufigen, oft quälenden nephrogenen Pruritus kann es im Rahmen einer Niereninsuffizienz zum Auftreten spezieller Krankheitsbilder kommen. Die erworbenen perforierenden Dermatosen sind meist ebenfalls stark juckend. Bei der Kalziphylaxie handelt es sich um eine schwere Erkrankung mit schlechter Prognose. Nicht heilende Wunden mit Superinfektion und Progredienz bis zur Sepsis sind charakteristisch. Bullöse Hautveränderungen können durch Störungen im Porphyrinmetabolismus verursacht werden. Erst im Jahr 2000 beschrieben und näher charakterisiert wurde die nephrogene systemische Fibrose, deren Inzidenz bereits wieder im Sinken begriffen ist. Der Beitrag vermittelt des Weiteren eine Übersicht über systemische Erkrankungen, die sowohl Hautsymptome als auch Nierenveränderungen aufweisen. Dazu zählen Kollagenosen, Vaskulitiden oder Sarkoidose und Amyloidose. Nach einer Nierentransplantation muss besonders auf Hauttumoren und Infektionen geachtet werden. Der letzte Teil dieses Beitrags ist Genodermatosen mit Haut- und Nierenbeteiligung gewidmet, wo zahlreiche ursächliche Mutationen bereits charakterisiert werden konnten. Die Kenntnis der Zusammenhänge von charakteristischen Hautsymptomen und bestimmten, potenziell lebensbedrohlichen Nierenerkrankungen ist wichtig, um weiterführende Untersuchungen und Schritte wie die Überweisung zum Nephrologen frühzeitig einleiten zu können.

Abstract

In addition to general skin changes like pallor or dryness and the frequent, often excruciating nephrogenic pruritus, specific diseases in patients with renal failure may occur. Acquired perforating dermatoses are usually also highly pruritic. Calciphylaxis is a severe disease with poor prognosis. Nonhealing wounds with superinfection and progression to sepsis are characteristic. Bullous lesions can be caused by disturbances in porphyrin metabolism. Nephrogenic systemic fibrosis is a disease which was first described in 2000. Its incidence is already on the decline. Furthermore, this article provides an overview of systemic diseases which have both skin symptoms and kidney changes. These include connective tissue diseases, vasculitis or sarcoidosis and amyloidosis. After a kidney transplantation, particular attention must be paid to the development of skin tumors and infections. The last part of this article is dedicated to genodermatoses with skin and renal involvement, where numerous causative mutations have already been characterized. Knowing the correlations of characteristic skin symptoms and specific, potentially life-threatening kidney disease is important in order to initiate further investigations and steps such as referral to nephrologists at an early stage.

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Authors and Affiliations

  1. Dermatologische Abteilung, Donauspital, Langobardenstr. 122, 1220, Wien, Österreich

    M. Schmid-Simbeck,  A. Udvardi &  B. Volc-Platzer

  2. Medizinische Forschungsgesellschaft Donaustadt, Langobardenstr. 122, 1220, Wien, Österreich

    M. Schmid-Simbeck,  A. Udvardi &  B. Volc-Platzer

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M. Schmid-Simbeck gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Schmid-Simbeck, M., Udvardi, A. & Volc-Platzer, B. Hautmanifestationen bei Nierenerkrankungen. Hautarzt 67, 960–969 (2016). https://doi.org/10.1007/s00105-016-3890-3

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