Kidney disease: 11 ways it can affect your skin

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

1. Extremely dry skin. Skin can become so dry that it:

   • Becomes rough and scaly
   • Feels tight and cracks easily
   • Develops fish-like scales
   Extremely dry skin is common in people who have end-stage kidney disease, which requires dialysis or a kidney transplant.

2. Itchy skin. Extremely itchy skin is a common symptom of advanced kidney disease. The itch can range from irritating to life-disrupting. Your skin may itch all (or most of) the time.
   

   Some people have itch on one area of their skin. The itch can also spread across most of your body.

3. Scratch marks and other signs of scratching. When you scratch often, it affects your skin. You can develop:

   • Raw, bleeding skin or sores
   • Thick, leathery skin (lichen simplex chronicus)
   • Firm, very itchy bumps (nodularis prurigo)
   If nothing seems to relieve the itch, you may want to see a dermatologist. Some people who have end-stage kidney disease get relief from a treatment called UVB phototherapy.

4. Color changes to your skin. When the kidneys stop working as they should, toxins build up in your body. This build-up can cause color changes to the skin. You may see any of the following:

   • An unhealthy pale color
   • Gray hue
   • Yellowish color
   • Areas of darkened skin, as shown here
   • Yellowish, 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.

5. 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, as shown here (half-and-half nails)
   • Pale nails
   • White bands running across one or more nails (Muehrcke’s nails)
   Because your nails reveal a lot about your health, see your doctor if you notice any changes to your fingernails or toenails.

6. Swelling. 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 build-up causes swelling, which you may notice in your:

   • Legs
   • Ankles
   • Feet
   • Hands
   • Face
   You may see the swelling in one or several areas of your body.

7. Rash. When 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 patches.

8. Blisters. Some people who have end-stage kidney disease develop blisters, which can form on their:

   • Hands (as shown here)
   • Face
   • Feet
   The blisters will open, dry up, and crust over. As they clear, scars appear.

9. 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 on the:

   • Side
   • Belly
   • Lower back
   Feeling a mass in one of these areas can also be a sign of something less serious going on inside your body. If you find any spot or lump, make an appointment to see your doctor.

10. Skin too tight to pinch. This is an extremely rare side effect that can occur when you get an MRI or another test that requires a contrasting agent. A doctor may request a contrast agent to get a better view inside an area of your body, such as a blood vessel. If you need a contrasting agent, it will be injected into a vein before your test.
    
    Gadolinium is a contrasting agent that can affect your kidneys. When this happens, it can cause:

    • Areas of hard, shiny skin that become too tight to pinch
    • Inability to fully bend a knee, elbow, or other part of your body
    • Skin that feels bound down
    This is a rare side effect. If you have kidney disease, be sure to tell any doctor who orders a medical test for you.

11. Calcium deposit under the skin. Your kidneys have several jobs. One is to balance certain minerals in your blood, such as sodium and phosphate. When the kidneys cannot maintain a healthy balance, levels can rise. Some people develop deposits of calcium in their skin, such as the patient in this picture. This patient also has half-and-half nails, which is another sign of kidney disease.
    
    Calcium deposits usually develop around a joint and are not painful. However, when they occur within a fingertip, they can cause a great deal of pain.
    

    If one of these deposits pushes up through the skin, you may see a chalky discharge.

How dermatologists help patients with kidney disease

Kidney doctors, called nephrologists, often care for patients with kidney disease. When a kidney disease affects the skin, a nephrologist may team up with a dermatologist. Some skin conditions that develop due to kidney disease can be difficult to control. For example, if a patient has extremely itchy skin, it may be impossible to sleep through the night. A board-certified dermatologist can help a patient get some relief. This may involve using the right balance of moisturizers and medication that you apply to the skin. Some patients get relief with a treatment called UVB phototherapy.

The right skin care may also help. If the kidney disease is causing extremely dry skin, these tips from dermatologists may help:

Self-care: Dry skin

¹ Centers for Disease Control and Prevention. “Chronic kidney disease in the United States, 2019.” Page last reviewed Mar. 11, 2019. Last accessed Feb. 27, 2020.

Images
Image 1: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Images 2, 3, 6, 9, 10: Getty Images

Images 4, 5, 7, 8, 11: Journal of the American Academy of Dermatology

• Image 4: Streams BN, Liu V, et al. “Clinical and pathologic features of nephrogenic fibrosing dermopathy: a report of two cases.” J Am Acad Dermatol. 2003;48(1):42-7.

• Image 5: Saray Y, Seçkin D, et al. “Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study.” J Am Acad Dermatol. 2004;50(2):197-202.

• Images 7, 8, 11: Robinson-Bostom L, DiGiovanna JJ. “Cutaneous manifestations of end-stage renal disease.” J Am Acad Dermatol. 2000;43(6):975-86.

References
Amin A, Burgess EF. “Skin manifestations associated with kidney cancer.” Semin Oncol. 2016;43(3):408-12.

Centers for Disease Control and Prevention. “Chronic kidney disease in the United States, 2019.” Page last reviewed Mar. 11, 2019. Last accessed Feb. 27, 2020.

Galperin TA, Cronin AJ, et al. “Cutaneous Manifestations of ESRD.” Clin J Am Soc Nephrol. 2014;9(1):201-18.

Girardi M, Kay J, et al. “Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations.” J Am Acad Dermatol 2011;65:1095-106.

Kobayashi TT. “Cutaneous manifestations of renal disease.” In: Fitzpatrick JE, et al. Dermatology Secrets Plus (5th edition). Elsevier. China, 2016:340-7.

Robinson-Bostom L, DiGiovanna JJ. “Cutaneous manifestations of end-stage renal disease.” J Am Acad Dermatol. 2000;43(6):975-86.

Saray Y, Seçkin D, et al. “Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study.” J Am Acad Dermatol. 2004;50(2):197-202.

Scheinfeld NS. “Nephrogenic systemic fibrosis.” Medscape. Posted May 22, 2018. Last accessed Feb. 27, 2020.

Streams BN, Liu V, et al. “Clinical and pathologic features of nephrogenic fibrosing dermopathy: a report of two cases.” J Am Acad Dermatol. 2003;48(1):42-7.

Van Amburgh JA. “How Is uremic pruritus treated?” Medscape Dermatology. Posted Feb 12, 2014. Last accessed Feb 27, 2020.

Van de Velde-Kossmann KM, “Skin examination: An important diagnostic tool in renal failure patients.” Blood Purif 2018;45:187–93.