Clinical Images

A Rare Dermatologic Manifestation of Renal Failure

Authors: Kaitlin Brooke, MD¹; Chelsea Tieszen, MD²; Avital Y. O’Glasser, MD, FACP³

1. Department of Medicine, Oregon Health & Science University
2. Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University
3. Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University

A 57-year-old gentleman with stage V chronic kidney disease and recurrent admissions for decompensated systolic heart failure presented with progressive dyspnea.   He was currently homeless and had lost his torsemide supply three days prior.   Physical exam was notable for JVP elevated to 15 cm, decreased bibasilar breath sounds and pitting lower extremity edema.  Labs revealed creatinine 8.26 mg/dL, BUN 91 mg/dL, and NT-ProBNP 180,916 pg/mL.  

In multiple conversations over several admissions, the patient had consistently declined hemodialysis initiation due to a complex psychosocial situation.  His profound volume overload was refractory to intravenous diuretics, and his cardiorenal syndrome worsened.  He ultimately requested hospice care, and in the following days, developed symptomatic uremia with anorexia, malaise, nausea, pruritus, asterixis, encephalopathy, and skin changes pictured.  

MCQ:

Identify the dermatologic finding pictured:

A) Seborrheic dermatitis

B) Xerosis

C) Uremic frost

D) Retention keratosis

Click for MCQ Answer and Discussion