Manifestations Of Chronic Renal Failure Research Articles

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

The effectiveness of feed additives in chronic kidney disease in cats

Chronic kidney disease in cats is one of the most common diseases. The main direction of palliative therapy for chronic kidney disease and extending the survival time of cats is to limit phosphates in the diet and normalize the phosphorus content in the animal’s body. In order to reduce phosphates, phosphate binders are used - substances whose mechanism of action is to bind excess phosphate ions in the gastrointestinal tract, which prevents their entry into the blood-stream. The purpose of the study is to analyze the effectiveness of feed additives “Urdetox” and “Ipakitine” in a comparative aspect in the palliative treatment of chronic kidney disease in cats. Determination of the biological activity of the proposed feed additive for cats with CKD in the form of tablets was carried out on the basis of veterinary clinics in the city. Volgograd, St. Petersburg, Moscow, in the period 2021-2022. The objects of the study were cats whose owners complained of loss of animal body weight, often a general depressed state, decreased appetite, periodic vomiting, frequent urination, dull hair. The diagnosis and experiment were carried out by collecting anamnestic data, determining clinical signs and laboratory data - a general urine test and a biochemical analysis of blood serum. Studies have shown that feed additives containing a phosphate binder and a detoxicant help eliminate the main clinical manifestations of chronic renal failure. The introduction of the essential amino acid -taurine into the feed additive in the form of Urdetox tablets, as well as the accuracy of dosing and ease of use increase the effectiveness of its biological action.

Imaging of Pulmonary Manifestations in Chronic Kidney Disease: A Review

AbstractLungs and kidneys share a symbiotic relationship in maintaining homeostasis of body. Hence, derangement of one system is bound to affect the functioning of the other. The thoracic manifestations of chronic renal failure present a wide spectrum ranging from problems related to fluid and salt balance, calcium–phosphate metabolism, compromised immunity, and additional issues related to different modes of dialysis. In most of the cases, chest radiograph coupled with ultrasound and computed tomography (CT) are sufficient to offer a definitive diagnosis. This review aims to summarize the imaging features of thoracic manifestations of chronic kidney disease (CKD) with emphasis on imaging-based discriminating features.

Rare clinical manifestations of chronic renal failure in the oral cavity

Rare clinical manifestations of chronic renal failure in the oral cavity

Adult Penoscrotal Edema as Manifestation of Chronic Renal Failure

Adult Penoscrotal Edema as Manifestation of Chronic Renal Failure

BLOOD CORTISOL CONCENTRATION, HEMODYNAMICS AND METABOLISM OF PATIENTS WITH SECONDARY HYPERPARATHYROIDISM, POSSIBILITIES OF PERIOPERATIVE CORRECTION

Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) of stage 3 or worse with manifestations of chronic renal failure (CRF) who undergo hemodialysis. Most of them have severe metabolic disorders, metabolic acidosis and a range of disorders associated with hyperparathyroidism and require parathyroid surgery (PTS). Aim of research. To assess the possibilities of metabolic correction in patients with SHPT with PTS, depending on the level of blood cortisol. Materials and methods. The study was carried out in the clinic of SIS «RPC PCM» SAD, Kyiv, Ukraine, was prospective, not randomized. The study group (n=133) included patients with severe SHPT manifestations due to end-stage chronic renal failure due to CKD, who underwent PTS. Patient age: 21-75 years old. Men – 69 (51,9%), women – 64 (48,1%). The degree of preoperative risk of ASA III-IV. Surgical interventions were performed under general anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl under conditions of low-flow artificial ventilation. The patients underwent a personalized energy monitoring developed and implemented in our clinic, using indirect calorimetry, by determining the index of current metabolism (Metabolic Rate Index, MRI, cal min-1 m2 ), basal metabolism (Basal Metabolic Rate Index, BMRI, cal min-1 m2), target metabolism (Target Metabolic Rate Index) and severity of metabolic disorders (Metabolic Disordes, MD,% = ). The patients were divided into two groups. The first group (I,72) consisted of patients who had reference values of the morning blood cortisol level before the operation – 171,03 and higher (173-374) nmol/L. The second group (II, 61) consisted of patients who had cortisol levels below this limit (91,5-168 nmol/L). In group I, intensive perioperative therapy was standard and aimed at supporting and correcting vital signs, according International Standards for a Safe Practice of Anesthesia 2010, WFSA. In group II, patients additionally received intravenous drip of 125-250 mg of prednisolone and further situationally hydrocortisone under the control of energy monitoring indicators. Results. In 45.9% of patients with SHPT and end-stage CKD, glucocorticoid insufficiency and low metabolic rate were diagnosed, which can lead to irreversible changes in organs or the life support system and increase the risks of perioperative complications and death in PTS. Preventive and perioperative administration of glucocorticoids under the control of energy monitoring, restores homeostasis indicators. Patients with normal blood cortisol levels did not have significant metabolic disorders. It was enough for them to follow the standard protocol of perioperative intensive care. Conclusions. Mandatory preoperative monitoring of blood cortisol levels in patients with SHPT against the background of end-stage CKD, who are on programmed hemodialysis, who are planned for PTS, is required in order to achieve a differential approach to treatment: to determine the need and dose of intravenous glucocorticoids.

ISSUES OF TREATMENT OF SECONDARY HYPERPARATHYROIDISM WITH THE EYES OF AN ANESTHESIOLOGIST. EXPERIENCE OF PERIOPERATIVE ANESTHESIOLOGICAL SUPPORT AND INTENSIVE THERAPY IN PARATHYROID SURGERY

Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) in the third and above stages with manifestations of chronic renal failure (CRF), especially in patients undergoing hemodialysis. Despite the temporary effects obtained from taking calcimimetics, there is no significant breakthrough in the treatment of SHPT, and most of the patients require parathyroid surgery (PTS). This review describes the main pathophysiological changes in SHPT, their correction, summarizes the indications for PTS, reflects preoperative preparation, anesthetic management, perioperative intensive care, and possible complications associated with SHPT and CRF. The experience of treating 214 patients with SHPT, 237 PTS (23 in connection with relapse of SHPT), algorithm of examination, preoperative preparation, anesthetic management and perioperative intensive care are presented. In the postoperative period, patients are at risk of severe hypocalcemia and hungry bone syndrome, which require careful monitoring and calcium replenishment.

Macronutrient status and indicators of acid-alkaline blood balance in cats with chronic renal failure

Chronic renal failure is a common pathology among cats. According to various literary sources, this pathology is found in 0.5–14.0% of cats. Pathology in cats in our studies is a consequence of glomerulonephritis. The diagnosis of chronic renal failure established on the basis of clinical, instrumental, and laboratory methods of blood and urine testing. Studies have found that chronic renal failure in cats is clinically characterized by apathy, anorexia, dry skin, odor of urea, vomiting, thirst, occurrence in the mouth of uremic ulcers (9.5% of patients), tachycardia (up to 177 beats per minute) tachypnoea (up to 45 respiratory movements per minute), hypertension. In the urine – hypostenuria, erythrocyturia, leukocyturia, kidney epithelium, hyaline and granular cylinders. According to echosonography – increase in echogenicity of the parenchyma, brain substance echone negative, cortico-brain differentiation erased. In the blood test – normochromic macrocytic anemia, thrombocytopenia, hyperazotemia (up to 27.9 mmol/L), hypercreatininemia (324 μmol/L), hyperuricemia (615 μmol/L), 4.6-fold increase in SDMA (symmetric dimethylargin). In chronic renal failure, cats have a significant change in the elemental composition of the blood. In particular, the Na+ content was increased by 3%, Ca2+ 1.6 times, P 2.1 times. Instead, the K+ level was reduced 1.9 times. Changes in acid-base equilibrium (ABE) were also detected: the pH decreased to 7.22; HCO3– by 34%, total CO2 by 32.3%, while anionic difference (AG) and buffer bases (BE) increased by 1.8 and 3.5 times, respectively. Such changes are characteristic of the development of lactic acidosis. The obtained experimental data on changes in mineral metabolism and acid-base equilibrium in the serum of cats in chronic renal failure supplement and clarify information on the pathogenic pathology of the kidneys in cats aged 5–10 years. Blood biochemical data can be used to improve early-stage diagnostics without clinical manifestations of chronic renal failure, their prevention and treatment, and to solve applied scientific problems in the field of nephrology and urology of small animals.

Anaemia in chronic kidney disease- new treatment options

In recent years anaemia has been recognized as one of the most specific and evident manifestations of chronic renal failure. In the majority of cases, renal anaemia is normocytic and normochromic with normal cellularity of bone marrow. Multiple factors contribute to the molecular origins of the anaemia of chronic kidney disease. Within those factors, the disturbances in the production of erythropoietin have the greatest impact on the disease pathogenesis. However, other components such as shortened erythrocyte survival, blood loss, iron or other nutritional deficiencies, hemolysis, the presence of uremic inhibitors of erythropoiesis among others can also significantly contribute to the occurrence of anaemia.

Chronic kidney disease and periodontal disease. Case report

Chronic renal disease promotes a decrease on kidneys filterability and nitrogen products accumulation on blood, electrolyte and system endocrine functions imbalance. Among the many clinical manifestations of chronic renal failure (CRF) in the oral cavity, there are: dry mouth, uremic stomatitis, radiographic changes in maxillary and jaw bones and accumulation of calculus on the teeth that increases levels of periodonto pathogenic microorganisms able to lead a periodontal tissue destruction and also have the potential to act from a distance on other organs, e.g. the kidneys. Thus, it becomes evident that a periodontal treatment of patients suffering from chronic renal failure is crucial for maintaining their general health conditions and a subsequent successful organ transplant.Thus, the objectives of this case report were to highlight how important the periodontal treatment is for chronic renal failure patients and to demonstrate improvements in their clinical condition through the treatment plan proposed herein. A patient with 43 years old carrier generalized moderate chronic periodontitis and CRF was submitted to scaling and root planning sessions, and later surgical access for scaling where the basic treatment not resulted in a resolution of the inflammatory periodontal process. The results obtained from a well-developed periodontal treatment and an effective cooperation of patient showed satisfactory results with periodontal disease process resolution or stabilization.Thus, periodontal treatment and patient compliance were crucial for the improvement of periodontal clinical conditions enabling a future successful renal transplantation.KeywordsDental care; Periodontal diseases; Renal insufficiency.

English

INTRODUCTION: The kidney and the skin are the two large networks of the body with their abundant blood supply, far in excess of their nutritional demands, the former for the constancy of the milieu interior and the latter maintaining mainly homeostasis. No wonder therefore, that they share many diseases and reflect mutually one another’s pathology which should be made use of by the clinician. Scientific and technologic improvements during the second-half of the 20th century have provided renal replacement therapy as a life sustaining option for many individuals who otherwise might have died. In each and every year of the last decade, the number of individuals with ESRD (end stage renal disease) has grown approximately from 20 to 30,000 per year. Cutaneous examination of patients with ESRD has shown that 50 – 100% of patients have at least one dermatologic condition. In addition to ESRD, uraemia and conditions associated with renal replacement therapy are fraught with numerous and often, relatively unique cutaneous manifestations. AIMS OF THE STUDY: 1. To study the various cutaneous manifestations and their incidence in patients with chronic renal failure. 2. To study the agewise and sexwise incidence of the individual cutaneous manifestation. 3. To study the incidence of cutaneous manifestations in renal transplant recipients. 4. To study the incidence of cutaneous manifestations of associated systemic disorder that may contribute to chronic renal failure. MATERIALS AND METHODS: This study was done for 2 years from October 2009 to October 2011 at Nephrology OPD, ward and medicine ward, Tirunelveli Medical College Hospital, Tirunelveli. Approval was obtained from the institutional ethical committee prior to the conduct of this study. During this period, 100 patients who had the presence of skin manifestations were selected and studied. 80 patients were known cases of chronic renal failure, diagnosed at Nephrology department or medical department and 20 patients were renal transplant recipients who were referral cases. Patient selection: Inclusion criteria: 1. Age : All ages, 2. Sex : Both males and females, 3. Patients with chronic renal failure, 4. Renal transplant patients. Exclusion criteria : 1. Patients with HIV infection, 2. Patients with previous malignancies, 3. Drug related cutaneous manifestations, 4. Patients on dialysis. SUMMARY: This clinical study of cutaneous manifestations of chronic renal failure and renal transplant recipients done during the period from October 2009 to October 2011, revealed the following: 1. Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus (58.8%) and xerosis (57.5%) were the most common among the specific cutaneous manifestations of chronic renal failure, which is similar to another study[104]. Pigmentary changes (55%) and nail abnormalities (56.2%) were the next. Mucosal and hair abnormalities were noted in good percentage of cases. Nearly 4 % had perforating dermatosis. Interesting findings noted in this study were digital gangrene, poor wound healing and restless leg syndrome. The onset of cutaneous manifestations after CRF ranges between 6 months to 3 years in this study. 2. Skin changes due to renal transplantation were mostly due to infections (excluding medication related disorders), with fungal infections (40%) being the most commonly noted. The next to follow was viral infections (35%) with verruca vulgaris being the commonest manifestation. The high incidence of cutaneous infections in these patients could be due to impaired immunity resulting in increased susceptibility to infections. Premalignant and malignant lesions were not noted in this study. After renal transplantation, there is improvement in pruritus in 9 (45%) patients and xerosis in 6 (30%) patients. 3. Skin changes specific to associated systemic diseases helped in finding various etiologies of chronic renal failure such as diabetes mellitus, systemic lupus erythematosus, scleroderma, vasculitis and ITP. 4. Other associated skin conditions were not related to etiology and were found to be just coincidental. CONCLUSION: Pruritus and xerosis were the most common among the specific cutaneous manifestations of chronic renal failure, followed by nail abnormalities and pigmentary changes. Calciphylaxis and uremic frost were not noted in any patient. The incidence of hair and nail abnormalities were more among females than males in this study. Cutaneous manifestations of renal transplantation were mostly due to infections, of which fungal infections were commonly observed followed by viral infections.

A clinical study of cutaneous and mucosal manifestations in patients with chronic renal failure on hemodialysis

<p class="abstract"><strong>Background:</strong> Chronic kidney disease is defined as presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function, quantified by measured or estimated glomerular filtration rate (GFR) that persists for more than 3 months.<span>Chronic kidney disease is major health problem. Chronic kidney failure presents with an array of cutaneous manifestations. </span>The objective of the present study was to determine the pattern of muco-cutaneous manifestations of chronic renal failure on hemodialysis<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A cross sectional study done in the Dermatology & Nephrology OPD of Sri Manakula Vinayagar Medical College and Hospital from October 2014 to May 2016. About 38 consenting patients who fulfilled the inclusion criteria were chosen for the study. The demographic characteristics were included in the study and the clinical profile of the patient such as hematological investigation and renal function tests were assessed. KOH mount, skin biopsy, Woods lamp, Grams stain and culture & sensitivity were done if needed after getting informed consent from the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The most common cutaneous manifestations in haemodialysis patients were xerosis and uraemic pruritus. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cutaneous manifestations like uraemic pruritus, Xerosis, Kyrle’s disease, infections, icthyosis & other lesions were seen with Xerosis beimg the most common feature. At least one cutaneous manifestation is found in all CRF patients.</span></p>

A Decrease in Glomerular Endothelial Cells and Endothelial-mesenchymal Transition during Glomerulosclerosis in the Tensin2-deficient Mice (ICGN strain)

The ICR-derived glomerulonephritis (ICGN) mouse is a unique model of nephrotic syndrome, and albuminuria becomes evident in a neonatal stage, due to a genetic mutation of tensin2. We previously provided evidence that an apparent decrease in nephrin, caused by tensin2-deficiencient states, leads to podocytopathy, albuminuria and eventually, chronic renal failure. In general, glomerular endothelial cells (ECs) function as a barrier through tight attachment of glomerular basement membrane to podocytes, while decreased ECs can worsen renal failure. Nevertheless, it is still unknown whether glomerular ECs are altered under the tensin-2-deficient states during the manifestation of chronic renal failure. Herein, we examined the changes of glomerular ECs, with focus on the expression of PECAM-1 and VE-cadherin (EC-specific markers), or of α-SMA (myofibroblast marker) in this mouse model by histological methods. Compared with the non-nephrotic (+/nep) mice, the nephrotic (nep/nep) mice exhibited the reduced expression of PECAM-1, or of VE-cadherin, in glomerular area. Notably, some glomerular ECs showed the positive stainings for both PECAM-1 and α-SMA, suggesting endothelial-to-mesenchymal transition (EndoMT) during progression of glomerular sclerosis. This is the first report showing that a decrease in glomerular ECs, at least in part, via EndoMT is involved in tensin2-deficient pathological conditions.

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

Anemia is one of the most common manifestations of Chronic Renal Failure (CRF), specially during the dialysis period. Growth failure and a high cardiovascular morbimortality are 2 of the most important consequences. Objective: To present a review of the current concepts in diagnosis and management of anemia in pediatric CRF patients. Erythropoietin (EPO) deficit is the main cause of anemia, requiring exogenous replacement through intravenous or subcutaneous route, in hemodialyzed or peritoneodialyzed patients respectively. A longer half-life allows to use EPO one or twice weekly when given by intraperitoneal route, in order to reach a target hemoglobin between 11-12 gr/dl, a level that avoids the cardiovascular risk associated to higher levels as described in adult CRF population. In pediatrics, 100-300 U/kg/weekly can be used to reach the desired hemoglobin levels, always monitoring about the potential complications of EPO, specially arterial hypertension. If anemia seems to be resistent to EPO therapy, iron deficit should be considered and properly treated, as described in this article. Ferritin and saturation of hemoglobin need to be routinely monitored to diagnose iron status in these patients, values less than 100 ng/ml and 20% respectively require exogenous suplementation. Iron doses in pediatrics still need to be defined. Anemia needs to be evaluated and treated in all CRF children, properly management must always be instaured in order to prevent its undesired effects.

HGF as a renotrophic and anti-fibrotic regulator in chronic renal disease

Hepatocyte growth factor (HGF) and Met/HGF receptor play roles in dynamic growth and morphogenesis during development and regeneration of organs, including the kidney. In the kidney, HGF targets different types of cells, while its biological actions depend on a target cell type. During the earlier stages of chronic renal failure, renal HGF expression increased, but in later stages HGF expression decreased, associated with manifestation of chronic renal failure. When anti-HGF IgG was administered into mice with chronic renal failure, renal dysfunction and fibrosis were accelerated, indicating a role of endogenous HGF to suppress chronic renal failure. For myofibroblasts, a key cell type in tissue fibrosis, HGF exerted biological activities, including (i) inhibition of growth, (ii) suppression of fibrogenic cytokine expression, and (iii) enhancement of matrix metalloproteinases involved in subsequent apoptosis. In models of glomerular and tubulo-interstitial fibrosis, administration of HGF or HGF gene therapy improved renal fibrosis and dysfunction. Since insufficient production of HGF is causative for renal fibrosis, supplementation with HGF represents a new approach to inhibit or improve chronic renal failure.

4-pyridone-3-carboxamide ribonucleoside triphosphate accumulating in erythrocytes in end stage renal failure originates from tryptophan metabolism

We recently identified an erythrocyte nucleotide accumulating in end-stage renal disease as 4-pyridone-3-carboxamide ribonucleotide triphosphate (4PYTP), a nucleotide never described previously. Plasma tryptophan concentration has been previously reported to be reduced in patients in chronic renal failure that is in turn associated with elevated precursors of tryptophan metabolism, including L -kynurenine and quinolinic acid, both of which have been implicated in the neurotoxic manifestations of chronic renal failure. Here we compare mean erythrocyte 4PYTP, and plasma tryptophan concentrations, in controls and four patient groups with renal impairment (10 per group) and confirmed a reduction in plasma tryptophan in patients on dialysis that corrected with renal transplantation. We found: An inverse correlation between plasma tryptophan and red cell 4PYTP concentrations (R(2)=0.44, P<0.001) when all patients were grouped together. Restoration of both tryptophan and 4PYTP concentrations to control values was only achieved following renal transplantation. 4PYTP was absent from erythrocytes in Molybdenum cofactor (MoCF) deficiency implicating aldehyde oxidase/dehydrogenase, a Molybdenum requiring enzyme. High 4PYTP erythrocyte concentrations in adenine or hypoxanthine-phosphoribosyltransferase deficient patients in severe uremia (113 microM and 103 microM), confirmed the lack of involvement of either enzyme in 4PYTP formation. We propose that 4PYTP is formed by a novel route involving the oxidation of the intermediates of NAD turnover from quinolinic acid by aldehyde oxidase.

Urinary Concentration Defect and Limited Expression of Sodium Cotransporter, rBSC1, in a Rat Model of Chronic Renal Failure

Background: Renal urinary concentration is associated with enhanced expression of sodium cotransporter (rBSC1) in thick ascending limb of Henle. Overexpression of rBSC1 was reported recently in hypertrophied nephrons after unilateral nephrectomy (UNX) and in kidney isografts. Since urinary concentration defect and hypertrophy of residual nephrons are major manifestations of chronic renal failure (CRF), we investigated the rBSC1 signals for RNA and protein in a rat model of CRF. Methods: Rats underwent 5/6 nephrectomy and examined 8 weeks after operation. rBSC1 mRNA was examined by competitive PCR and in situ hybridization, and rBSC1 protein signals by western blotting and immunohistochemistry. Rats that underwent sham-operation, UNX, or 5/6 nephrectomy followed by a 3-week recovery period (acute renal failure), were used as control. Water intake was restricted for 24 h in subgroups of control and CRF rats. Results: Microscopic examination showed hypertrophy of residual nephrons in both UNX and CRF rats. Signals for rBSC1 mRNA and protein were enhanced at basal condition only in rats with UNX. Under basal conditions, CRF rats demonstrated low urinary osmolality in spite of high plasma arginine vasopressin levels. Water restriction resulted in increased signals for rBSC1 mRNA and protein and concentration of urine in sham-operated rats, but such increases were absent and urinary concentration was incomplete in CRF rats. Conclusions: Compensatory overexpression and upregulation of rBSC1 expression in response to dehydration are both absent in CRF rats. These limitations are thought to be the underlying mechanisms of urinary concentrating defect seen in CRF.

GI manifestations of chronic renal failure

Abstract The gastrointestinal (GI) manifestations of chronic renal failure (CRF) can be viewed in 3 categories: (1) GI manifestations that are the consequence of CRF, (2) GI manifestations associated with the treatment of CRF including dialysis and renal transplantation with associated chronic immunosuppression, and (3) GI manifestations of diseases associated with both GI dysfunction as well as CRF. CRF rarely is associated with distinct manifestations of GI dysfunction. The major manifestation is an increased risk for GI bleeding, associated with vascular lesions of the GI tract. The GI consequences of treatment of renal failure including dialysis, transplantation, and immunosuppression may be diverse and protean. Dialysis is associated with an increased risk for viral hepatitis. Immunosuppression is associated with opportunistic infections. In addition, drugs associated with posttransplant immunosuppression predispose to gastritis, peptic ulcer disease, and mucosal injury, as well as drug-induced pancreatits and hepatitis. Finally, numerous multisystem diseases may be etiologic for both GI and hepatic dysfunction as well as CRF. These disorders include diabetes, arteriosclerotic vascular disease, collagen vascular diseases, and autoimmune diseases. Copyright 2002, Elsevier Science (USA). All rights reserved.

GI manifestations of chronic renal failure

GI manifestations of chronic renal failure

Cutaneous manifestations of chronic renal failure in children of color.

One hundred percent of adult patients with chronic renal failure (CRF) develop cutaneous findings as a result of uremia or due to therapeutic interventions. To date, pediatric incidence studies have been limited to Caucasian children. However, recent reports have indicated that more African American patients progress to end-stage renal disease (ESRD). This is the first study to assess the prevalence of renal failure-related skin disease in children of color, including African American and Hispanic patients. Thirty children were evaluated by history and physical examination, with assignment to one of three treatment categories: transplanted (n = 10), dialyzed (n = 16), or medically managed (n = 4). Skin findings were divided into uremic, drug-related, or infectious disease types. The incidence of skin disease was 100%. Xerosis was the single most common finding, often accompanied by pruritus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high incidence of gingival hypertrophy (72%) and an even higher incidence of hypertrichosis (100%). Acral warts and nevi were common findings, the latter correlating with the length of immunosuppression. There is a high incidence of cosmetically disfiguring side effects (Cushinoid facies, hypertrichosis, and gingival hypertrophy) in children within all treatment categories, primarily related to drug treatment. Further study is required to determine the long-term sequelae, including psychological disturbances, of cutaneous disease in children of color with CRF.