Attia Enas A S, Hassan Ahmed A
Department of Dermatology, Venereology and Andrology, Ain Shams University Hospital, Cairo, Egypt.
Department of Nephrology, Internal Medicine, Zagazig University Hospital, Zagazig, Egypt.
Arab J Nephrol Transplant. 2014 May;7(2):91-6.
Uremia is the most important systemic cause of pruritus. Uremic pruritus (UP) was found to affect 50-90% of patients undergoing dialysis and about 25% of patients with chronic kidney disease (CKD). Despite its high prevalence, morbidity and the marked influence on quality of life, UP remains poorly characterized.
Triggering factors for UP may include cutaneous xerosis, uremic toxins, systemic inflammation and associated common co-morbidities such as diabetes mellitus, endocrinopathies,viral hepatitis and somatic neuropathy. Moreover, high pre-dialysis levels of blood urea nitrogen (BUN), β2-microglobulin, calcium and phosphate, as well as parathyroid hormone (PTH) were found to be related to UP. A new hypothesis of glycation, with advanced glycation end products (AGEs) accumulation in stratum corneum has been proposed as a possible underlying cause of UP. Common treatments used for UP include antihistamines, steroids, emollients, charcoal, erythropoietin and phototherapy (UVB). Other treatments with some reported efficacy are serotonin antagonists, selective serotonin reuptake inhibitors (SSRI), mast cell stabilizers, leukotriene receptor antagonists, κ-opioid agonists and nicotinamide. Many non-pharmacological treatments, including acupressure, are also used. In addition, improvement of dialysis modalities could relieve patients of UP. The future use of anti-glycation preparations for treatment of UP is supported by recent researches.
Recent researches on the process of glycation as a possible cause of UP may open the way for treatment with anti-glycation preparations. Nevertheless, associated co-morbidities with possible role should be concurrently treated.
尿毒症是瘙痒最重要的全身性病因。尿毒症性瘙痒（UP）在50% - 90%的透析患者以及约25%的慢性肾脏病（CKD）患者中被发现。尽管其患病率高、发病率高且对生活质量有显著影响，但UP的特征仍不明确。
UP的触发因素可能包括皮肤干燥、尿毒症毒素、全身炎症以及相关的常见合并症，如糖尿病、内分泌疾病、病毒性肝炎和躯体神经病变。此外，透析前血尿素氮（BUN）、β2 -微球蛋白、钙和磷以及甲状旁腺激素（PTH）水平升高与UP有关。一种新的糖化假说被提出，认为角质形成层中晚期糖基化终产物（AGEs）的积累可能是UP的潜在病因。用于UP的常见治疗方法包括抗组胺药、类固醇、润肤剂、活性炭、促红细胞生成素和光疗（UVB）。其他有一些疗效报道的治疗方法包括5 -羟色胺拮抗剂、选择性5 -羟色胺再摄取抑制剂（SSRI）、肥大细胞稳定剂、白三烯受体拮抗剂、κ -阿片受体激动剂和烟酰胺。许多非药物治疗方法，包括指压疗法，也被使用。此外，改善透析方式可以缓解患者的UP症状。近期研究支持未来使用抗糖化制剂治疗UP。
近期关于糖化过程可能是UP病因的研究可能为抗糖化制剂的治疗开辟道路。然而，应同时治疗可能起作用的相关合并症。
