To Determine the Risk of Chronic Kidney Disease in Patients with Psoriasis and to Evaluate the Spectrum of Renal Abnormalities in Psoriatic Patients

Aiswarya Jawahar, (2017) To Determine the Risk of Chronic Kidney Disease in Patients with Psoriasis and to Evaluate the Spectrum of Renal Abnormalities in Psoriatic Patients. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Psoriasis is a common, chronic, disfiguring, systemic inflammatory and proliferative condition of the skin, in which both genetic and environmental influences have a critical role. The most characteristic lesions consist of red, scaly, sharply demarcated, indurated plaques, present particularly over extensor surfaces and scalp. The disease is enormously variable in duration, periodicity of flares and extent. The pathophysiology of psoriasis is not completely understood, but the trigger of the keratinocyte response is thought to be the activation of the cellular immune system including T cells, dendritic cells, and various cytokines and chemokines. The prevalence of renal disease in psoriatic patients is unknown ; recently, the number of references describing an association between psoriasis and glomerulopathies has increased. Whether the renal involvement in psoriasis is coincidental or causative is debated. AIMS AND OBJECTIVES: To determine the risk of chronic kidney disease in patients with Psoriasis and to evaluate the spectrum of renal abnormalities in Psoriatic patients. Certain glomerular diseases: • IgA nephropathy, • Secondary renal amyloidosis, • Membranoproliferative glomerulonephritis, • Membranousglomerulopathy. Have been reported to be more common in psoriatic patients than in the general population. In the systemic management of severe psoriasis drugs with nephrotoxic side effects are frequently used like cyclosporine and methotrexate. However, several reports describe abnormalities in renal function (mainlymicroalbuminuria) in psoriasis patients who had never been exposed to nephrotoxic drugs. This observational study aims to evaluate the prevalence and type of renal abnormalities in patients with psoriasis, with the aim of determining whether renal disease is more prevalent in psoriasis patients than in the control group and if it affects the outcome of the cutaneous disease. MATERIALS AND METHODS: SOURCE OF DATA: Psoriasis patients attending Dermatology OPD and age-and gender-matched healthy controls in Govt. Stanley Medical College. PLACE OF STUDY: Dept. of Dermatology, Govt. Stanley Medical College. Dept. of Nephrology, Govt. Stanley Medical College. TYPE OF STUDY: Prospective, Observational study. TIME DURATION: January –June 2016. SAMPLE SIZE: 100 cases + 100 controls. STUDY PROCEDURE: A brief and relevant medical history and detailed drug history and physical examination will be done at screening visit to ensure relevant eligibility criteria with reference to disease severity and associated co-morbidities. Incident and prevalent psoriasis patients over 12 years of age from our hospital outpatient dermatology clinic will be for included in the study. The psoriasis area and severity index (PASI) will be used to assess the severity and extent of psoriasis. The PASI score is based on the extent of psoriatic involvement of body surface area on four anatomical sites, as well as the severity of scale formation, erythema, and plaque induration in each site of the body. Equal number of age-and gender-matched control subjects who fulfill the inclusion criteria over the age of 12 will be recruited on a volunteer basis from the OPD. Patients and controls will be explained about the procedure, benefits, possible side effects and prognosis of the testing. Written and informed consent will be taken. Digital photograph of skin lesions will be taken. All patients and controls will have blood drawn for blood urea, serum creatinineand electrolytes determination. In all patients and controls, urine samples will also be collected on admission for urinalysis (not necessarily from the first morning void). Samples are to be tested for the presence of blood, protein, and other abnormalities. All abnormal urinalyses are to be performed twice. Psoriasis vulgaris patients and controls with renal function test abnormalities may need to undergo additional laboratory tests, including serum lipids and uric acid, viral hepatitis and HIV serology, screening for antinuclear antibodies (ANA) antibodies. Abdominal ultrasonography will be done for all the patients and controls. A percutaneous renal biopsy may be required in psoriasis patients presenting with renal function test abnormalities and with normal abdominal ultrasonography (13,14). INCLUSION CRITERIA: 1. Psoriasis patients and controlswilling to undergo renal function tests, 2. Patients and controls willing for follow up in Nephrology OPD, 3. Male and female psoriasis patients and controls more than12 years of age, 4. Moderate to severe psoriasis patients with PASI>10. EXCLUSION CRITERIA: 1. Presence of any other dermatological disease, 2. Mild psoriasis with PASI<10, 3. Co-morbidities such as diabetes, 4. Pre-existing renal disease, 5. Pre-existing Autoimmune disease, 6. Immunesuppression or bleeding diathesis, 7. Pregnant or lactating women. INVESTIGATIONS: 1. Complete blood count and Liver Function test, 2. Blood Urea and Serum creatinine, serum electrolyte levels, 3. Urine microscopy for Blood, Protein, Albumin,and deposits, 4. Blood glucose levels, 5. Serology for HIV, Hbs-Ag, 6. Serum Uric acid and lipid levels, 7. Screening for ANA –if needed, 8. Abdominal ultrasonography, 9. 24 Hours Urine protein-creatinine ratio- if needed, 10. Renal biopsy – if needed. RESULTS: To determine the risk of chronic kidney disease in patients with moderate to severe Psoriasis compared to the control population and to evaluate the spectrum of renal disease in these patients and to determine the impact of renal disease on the outcome of Psoriasis. CONCLUSION: • Psoriasis is an immune mediated disease with multi-organ involvement with an underlying background of chronic inflammation. • Chronic kidney disease in psoriasis is a rare entity. • Patients with moderate to severe psoriasis, early onset psoriasis, long standing, more inflammatory types of psoriasis like pustular psoriasis and psoriatic arthritis are more prone for the development of chronic kidney disease. • The renal function tests including blood urea, serum creatinine, serum albumin and serum electrolytes were normal in our study population. • Though there were no tell tale signs of subclinical glomerular dysfunction in our group of psoriasis patients, some urinary abnormalities were observed in a minor group of patients • However in our patients the prevalence of microscopic hematuria and proteinuria was slightly more than healthy individuals, even if not statistically significant. • The proteinuria and hematuria observed in our patients was not significant enough to warrant an invasive procedure like renal biopsy. • These patients require long term follow up and if there is an increase in the lab parameters they may require a renal biopsy in the future. • There is a need for more advanced investigations to give more conclusive results. • Thus we cannot ignore the entity called soriatic nephropathy and routine screening of patients with renal function tests like estimation of blood urea, serum creatinine, urine albumin excretion rate, protein creatinine ratio should be an important part of the armamentarium in the management of chronic psoriasis.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201430051
Uncontrolled Keywords: chronic kidney disease, psoriasis, spectrum of renal abnormalities, psoriatic patients.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 22 Jul 2020 16:26
Last Modified: 22 Jul 2020 16:35

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