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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
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Nephrons01:10

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The kidneys are intricate organs with millions of working units known as nephrons. Each nephron features two major structures: the renal corpuscle, which facilitates blood plasma filtration, and the renal tubule, which handles the glomerular filtrate. Blood supply is directly linked to the nephrons. The renal corpuscle consists of the glomerulus, a capillary network, and the Bowman's capsule, a double-walled epithelial structure that encases the glomerulus. The filtering of blood plasma...
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Chronic kidney disease and itch.

Seyyede Zeinab Azimi1, Ethan A Lerner1

  • 1Center for Research & Training in Skin Diseases & Leprosy, Tehran University of Medical Sciences, Tehran, Iran and Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Itch (Philadelphia, Pa.)
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Summary

Chronic kidney disease-associated pruritus (CKD-aP) is a common, difficult symptom. While difelikefalin offers some relief, new treatments targeting mas-related G protein-coupled receptors show future promise for CKD-aP.

Keywords:
Chronic kidney diseaseDifelikefalinItchMas-related G protein–coupled receptorsPruritus

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Area of Science:

  • Nephrology
  • Dermatology
  • Pharmacology

Background:

  • Chronic kidney disease-associated pruritus (CKD-aP) is a widespread and difficult symptom for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
  • The exact causes of CKD-aP are not fully understood, making it a significant healthcare challenge.
  • Current treatments for CKD-aP are not consistently effective.

Purpose of the Study:

  • To review and update current evidence on the pathogenesis and treatment of pruritus in CKD.
  • To explore emerging therapeutic targets for CKD-aP.

Main Methods:

  • Literature review of existing evidence on CKD-aP.
  • Analysis of the pathophysiology involving uremic toxins, inflammation, opioid system, and mast cells.
  • Evaluation of current and novel therapeutic strategies.

Main Results:

  • Pathogenesis is multifactorial, involving uremic toxins, inflammation, opioid dysregulation, and mast cell activation.
  • Difelikefalin, a kappa-opioid receptor agonist, is the most recent FDA-approved treatment for CKD-aP.
  • Altered hemoglobin metabolism and mas-related G protein-coupled receptors (MRGPRs) represent a promising area for future drug development.

Conclusions:

  • CKD-aP remains a complex condition with limited satisfactory treatments.
  • Difelikefalin offers a new therapeutic option, but further research is needed.
  • Targeting MRGPRs may provide future therapeutic benefits for patients suffering from CKD-aP.