9 Skin Signs That May Indicate Your Kidneys Are Damaged

TRANSCRIPT

It is important to know that skin changes usually appear when you’ve already been having problems with your kidneys for a while.

Remember, early detection and treatment can make a world of difference in kidney health.

According to the latest studies, more than 800 million people worldwide may experience chronic kidney disease (1).

So, if you have any risk factors (such as high blood pressure, diabetes, or obesity) or if you suspect kidney problems, check for these skin signs and discover helpful tips for keeping your skin healthy.

Before we dive in, please note, all the information in this video is created by real people, thoroughly fact-checked, unbiased, and reviewed by qualified professionals.

Skin signs of kidney disease

Some skin changes are specific to kidney disease, whereas other changes in the skin are non-specific and may be associated with a variety of medical problems (2).

1. Itchy skin (pruritus)

This is one of the most common skin symptoms in people with kidney damage, occurring in as many as 40 percent of people with end-stage renal disease (ESRD) (3). But what causes this itchiness?

When the kidneys cannot effectively filter out waste products, urea accumulates in the blood. This build-up can lead to uremic pruritus, the medical term for itching caused by kidney disease (3).

Itchy skin can occur anywhere on the body, but it commonly affects the back, legs, and arms. It is intensified by sweat, dry skin, and heat (4, 5). While it may sound mild, this itchiness can be so intense and persistent that it can lead to a poor quality of life.

When the pruritus is severe, the urgent need to scratch leads to more severe skin problems. Scratching may cause scrapes (excoriations) on the skin thickened, leathery skin (skin lichenification), or raised bumps (prurigo nodularis) (6).

Ongoing scratching can cause lesions to bleed, and a compromised skin barrier becomes an easy way for bacteria to enter and lead to more severe infections.

2. Rashes

Rashes are also a common skin sign in people with kidney damage caused by poor elimination of toxins that build up in the skin.

Acquired perforating dermatosis is a type of rash that appears in individuals with end-stage kidney damage, in the form of small, pigmented, itchy bumps with a scaling center. These bumps can usually be found on arms and legs. Less commonly, they may be found on the trunk, scalp and buttocks (7).

As the bumps heal, new ones can appear, creating lesions in multiple stages of healing, which may join together to form larger patches.

Although these rashes are often itchy, you should avoid scratching because it can lead to worsened skin conditions.

3. Blisters

Blisters may also occur in people with kidney damage. They often appear as fluid-filled sacs on exposed areas such as the backs of the hands, forearms or, less often, on the feet and the face.

Kidney damage is just one potential cause of blisters. Blisters can be caused by infections, medications, poor diet, and heavy alcohol intake (2, 8).

Blisters associated with kidney damage can vary in size and severity. They may be accompanied by other symptoms such as pain, redness, and swelling.

Unfortunately, when blisters heal, they dry up and develop a crust that later peels away, usually leaving a scar and skin discoloration.

4. Calcium deposits

Calciphylaxis is one of the most severe skin conditions associated with kidney damage. It occurs when calcium accumulates in small blood vessels, leading to painful sores and ulcers.

It’s a rare but serious condition that occurs in up to four percent of patients undergoing dialysis and requires immediate medical attention (9).

The exact cause of calciphylaxis remains unclear, but several factors can increase the risk:

High blood calcium levels: This often happens due to imbalances in calcium and phosphate.
Dialysis: Long-term dialysis patients are more at risk.
Obesity: Higher body mass index (BMI) can be a contributing factor.
Medications: Certain medications can impact calcium metabolism.

Patients with calciphylaxis describe painful, pink, or purple bumps or plaques that develop into deep, painful ulcers covered with black crusts, usually located on the abdomen, buttocks, and legs (9).
Another type of calcium accumulation is represented by calcinosis cutis, which refers to calcium deposits under the skin. These are usually firm white nodules near joints that may break through the skin and release a white chalky discharge.

Calcinosis cutis are usually not painful unless they are located in the fingers or toes (10).

5. Dry skin (xerosis)

Dry skin or xerosis is one of the most common skin signs of kidney damage. However, dry skin is non-specific, as it can be caused by a number of conditions besides kidney damage. Dry skin occurs in 50 to 80 percent of individuals on dialysis, and here are a few common causes (11):

Poor hydration
Decreased sweat gland activity
High levels of vitamin A
Long-term use of diuretics

Xerosis usually occurs in those who have been dealing with kidney damage for a while and are on dialysis, which often causes skin to become dry, rough, and scaly. People with xerosis also experience tight skin that can easily crack, leading to exposed entryways for bacteria (12).

6. Swelling

The kidneys have many functions, one of the most important ones being the elimination of excess water and salt from our bodies.

If your kidneys are damaged, water and salt may not be eliminated properly, leading to a build-up of fluid.

This water and salt retention causes swelling and puffiness, especially in the hands, feet, and face. If your legs feel puffier than usual, press them with your finger to see if it leaves an indentation, called pitting edema (13).

If you experience swelling and puffiness, you should see your healthcare provider to have your kidney function evaluated.

7. Changes in skin color

The presence of kidney damage can lead to a build-up of waste products in your bloodstream, which may cause your skin to change color, often with gray or yellow hue.

This discoloration results from the toxins that are not being filtered and excreted in the urine. Skin hyperpigmentation may also occur, as a result of a buildup of melanin, and it may be seen as a dark brown color (8).

Skin pallor (paleness) is commonly observed in individuals with chronic kidney disease, caused by anemia.

Another skin discoloration related to kidney damage is uremic frost, a white, powdery substance left on the skin’s surface after sweat dries.

Excessive scratching may also change the color or texture of your skin (14).

8. Nail disorders

Many medical conditions can cause nail changes, including kidney disorders. In a study of 100 patients, nail changes were found in 60 percent of individuals with CKD (15). In another study of 101 patients with severe renal disease who were on dialysis, hair, mucosal, and nail disorders were found in 23 to 45 percent of the patients (16).

On your finger or toenails, you may notice one white transverse band, called Mees line, or multiple bands, called Muehrcke’s lines. These can appear in people with kidney damage due to stress or low protein levels in their blood (17, 18).

Another frequent finding is the ‘half and half’ nail disorder, also known as ‘Lindsay’ nails, characterized by a brownish color at the top of the nails from increased melanin, and a white or pink color at the bottom of the nails due to an increased number of small blood vessels (19).

Less common changes are splinter hemorrhages, which are small, red, or brown lines under the nails that resemble splinters.

They can be a sign of underlying health issues, including kidney damage, and they are caused by small blood clots that damage the capillaries under the nails (15).

Keeping nails trimmed and moisturized can reduce the risk of nail disorders.

9. Hair disorders

One of the most troubling symptoms for individuals with kidney damage is hair loss. This condition, medically known as alopecia, can have an impact on self-esteem and quality of life. Hair loss can result from several factors associated with kidney disease:

Nutritional deficiencies: Kidney damage often leads to imbalances in essential vitamins and minerals, such as iron and zinc, which are critical for healthy hair growth.
Hormonal imbalances: The kidneys regulate many different hormones that affect hair growth. When the kidneys are not working properly, it can lead to hormone dysregulations, which can affect hair growth cycles.
Medications: Some of the medications prescribed for kidney disease, including certain blood pressure medications and immunosuppressants, can contribute to hair thinning and loss.

Dehydration and dialysis treatment can strip hair of natural oils, making it more dry and brittle (2, 16).

It is important to remember that hair loss and hair shedding can occur from a variety of medical conditions. If you are experiencing a sudden increase in hair shedding or patches of alopecia, see your healthcare professional to help determine the cause.

What can you do?

We covered many skin signs, some more severe that would make us call our doctor and other more common ones that may not necessarily be related to kidney damage. So, the question that follows is:

When to seek medical help and who to consult for these symptoms?

As this video shows, some skin symptoms are more specific, or serious and clearly require a visit to a healthcare provider.

But what do we do about those less alarming symptoms that we might ignore or confuse with other causes?

Kidney damage affects many people, but there are some risk factors for kidney disease that you should consider when you notice skin changes.

If you are over 60 with other conditions such as high blood pressure, diabetes, or obesity, pay close attention to your skin and nail changes, even seemingly ordinary ones.

You should contact your primary care doctor at any sign of skin changes. Blood and urine tests will help diagnose kidney problems, allowing you to start proper treatment recommended by a nephrologist (kidney doctor).

You must communicate well with your doctor, who can explain your condition and how to prevent further skin changes. If you have severe or persistent skin symptoms, you should see a dermatologist (skin doctor) who can collaborate with your nephrologist.

How can I manage these symptoms by myself?

After being diagnosed, you should initiate proper treatment, but you should not rely only on medication.

Our lifestyle and day-to-day practices play a key role in the healing process. You need to make important changes to manage kidney damage. These changes include:

Diet and nutrition: Eating a balanced, kidney-friendly diet is important for your skin health. Monitor your salt, protein, phosphate, and calcium intake. Quit smoking and limit or avoid alcohol consumption. Search for new recipes or talk to a nutritionist who can recommend dishes based on your favorite flavors (21).
Hydration: Drinking enough water can help keep your skin hydrated and reduce dryness. However, if you have kidney issues, especially if you are on dialysis, overhydration can lead to fluid build-up. To manage thirst when restricting fluids, eat pieces of frozen fruit, drink small sips, or rinse your mouth with mouthwash (20). Consult your healthcare provider to determine your ideal water intake (21).
Moisturizing: To combat dryness and itchiness, moisturize your skin at least once a day. Use fragrance-free, hypoallergenic moisturizers to avoid irritation. Emollients that contain salicylic acid or urea and a gentle skin care regimen can be useful (4).
Avoiding hot showers and baths: Hot showers can strip your skin of its natural oils, making it dry and itchy. Avoid long baths and try taking short showers with lukewarm water.
Avoiding harsh skincare products: Avoid using harsh soaps and skincare products that can irritate your skin. Stick to gentle, fragrance-free products designed for sensitive skin.
Sun protection: Sun damage can worsen skin problems, especially if your skin is sensitive. Use sunscreen with at least SPF 30 to protect your skin, even on cloudy days, and re-apply it throughout the day. .
Comfortable clothing: Wear loose-fitting, comfortable clothing made from natural fibers like cotton. This can help prevent irritation and allow your skin to breathe.
Regular check-ups: Regular check-ups are essential for monitoring your kidney function and overall health. Discuss any new symptoms or concerns with your doctor during these visits.

Summary

When it comes to kidney health, recognizing skin signs is crucial for early diagnosis and effective management. Kidney damage often causes specific symptoms like itchy skin, rashes, blisters, and calcium build-up in vessels and skin.

It can also lead to non-specific signs such as dry skin, swelling, changes in skin color, nail, and hair disorders. Each of these symptoms signals potential underlying renal problems.

Itchy skin, for example, affects 90 percent of people on hemodialysis due to the build-up of waste products like urea.

Similarly, rashes, blisters, and calcium deposits signal that the kidneys struggle to eliminate toxins effectively.

Although less specific, nail and hair disorders should not be ignored, especially in those with associated risk factors, as they can signal deteriorating kidney function.

People with kidney disease should watch for these symptoms, especially if they are at high risk, due to factors like age over 60, diabetes, high blood pressure, or obesity.

Early detection can significantly improve treatment outcomes. Seek immediate medical help when these signs appear. Blood and urine tests will confirm the diagnosis and pave the way for proper treatment, often involving collaboration between a nephrologist and dermatologist.

Managing these symptoms involves more than just medical treatment. Lifestyle changes play a crucial role. These include maintaining a balanced diet, staying hydrated without excess, using gentle skincare products, avoiding hot showers and harsh soaps, and ensuring proper sun protection. Such changes can greatly improve your quality of life and skin health.

In conclusion, recognizing and addressing skin signs linked to kidney damage on time helps diagnosis and management of the condition. Adopting a proactive approach helps manage the symptoms and improves overall kidney health and quality of life.