Renal (uraemic) pruritis

30-50% of patinets with CKD get uraemic pruritis

Aetiology (combination of factors):

• Dry skin
• Reduced sweating
• Abnormal Ca/PO metabolism and raised PTH = causes mast cell degranulation
• toxin accumulation
• systemic inflammation

PC - Itch worse at night. relief with physical acitivity, cool temp, hot or cold showers. fluctuations of Sx during haemodialysis sessions

Ix - U and E, Bone profile, PTH

Rx - Optiomise CKD treatment and dialysis, normalise PTH/Ca/PO levels, emollients, phototherapy (if severe)

Hepatogenic pruritis

Due to cholestasis - causing itching in hands and feet of 20-25% of jaundiced patients

Tx - Treat underlying cause of cholestasis, bile salt resins such as cholestyramine are first line

Haematological

Certain haematological conditons can cause pruritis:

• Polycythaemia rubra vera
• Iron deficiency anaemia