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Kidney Disease And Psoriasis A New Comorbidity

Spondyloarthritis And Psoriatic Arthritis

Comorbidity in chronic kidney disease

Thirty-five percent of patients with ankylosing spondylitis display abnormal serum creatinine measurements or urinalyses, often resulting from glomerular deposition of amyloid A or IgA . Drug-induced nephrotoxicities – for example, interstitial nephritis or NSAID-associated membranous GN – are important differential diagnoses that deserve different therapeutic approaches. Amyloid-A nephropathy requires aggressive control of the underlying rheumatic disease, whereas NSAID-induced interstitial nephritis or membranous GN requires cessation of these drugs. In the latter case, glucocorticoids or TNF-blocking biologicals are alternative options for antiphlogistic therapy, and acetaminophen, metamizol/dipyrone or opioids should be used as alternative analgesic medications. Importantly, amyloid-A nephropathy and NSAID-induced membranous GN may both present through nephrotic syndrome, requiring a renal biopsy to make a diagnosis. Patients with psoriatic arthritis and other spondyloarthritides may also present with IgA nephropathy or amyloid-A nephropathy. In psoriatic arthritis patients, elevation of serum creatinine values and/or proteinuria correlates with age, disease activity and duration .

Pathogenesis Of Chronic Plaque Psoriasis

Collectively, a pathogenic cross-talk between DCs, T cells, and keratinocytes, sustained by type I IFNs, IL-23, IL-12, IFN-, IL-17, TNF-, and IL-22, and possibly supported by other immune cell players, causes keratinocyte production of pro-inflammatory molecules, as well as concurs to derange proliferative and differentiative programs of the epidermis. This becomes a self-amplifying loop, where these products and altered homeostasis act back on T cells and DC to perpetuate the cutaneous inflammatory processes.

The Importance Of Treatment

Psoriasis is a chronic autoimmune condition that cant be cured. It begins when your immune system essentially fights against your own body. This results in skin cells that grow too quickly, causing flares on your skin.

The effects of this condition include more than just skin lesions. Other medical consequences can result such as psoriatic arthritis or other comorbidities.

PsA is a disease that affects the joints. Symptoms include pain, inflammation, and stiffness in your joints. It affects up to 30 percent of those with psoriasis.

Comorbidities are other health conditions that may arise with psoriasis. You may be at risk for several serious health conditions, such as:

  • cardiovascular conditions
  • erectile dysfunction
  • alcoholism

These wide-ranging health implications require you to manage your psoriasis effectively. Most likely, this will involve a variety of treatments. Delaying treatment or ignoring symptoms puts you at risk for the condition to get worse. Its imperative that you talk to your doctor when symptoms develop. Your doctor will work with you to create an effective treatment plan.

Psoriasis is a condition that requires individual treatment plans because the causes of it are unknown. Research suggests that this condition could be caused by:

  • your immune system
  • your genes
  • environmental factors

This lack of understanding about the cause of psoriasis means that there is no one-size-fits-all treatment for it at this time.

  • maintaining a healthy diet

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Statin Use And The Risk Of Chronic Kidney Disease In Patients With Psoriasis: A Nationwide Cohort Study In Taiwan

  • Kwei-Lan Liu,

    Roles Conceptualization, Funding acquisition, Investigation, Validation, Visualization, Writing original draft, Writing review & editing

    Affiliation Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

  • Roles Data curation, Methodology, Validation, Writing review & editing

    Affiliation Huang PH Dermatology and Aesthetics, Kaohsiung, Taiwan

  • Contributed equally to this work with: Hung-Pin Tu, Chih-Hung Lee

    Roles Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Visualization, Writing original draft

    * E-mail:

    Affiliation Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

  • Contributed equally to this work with: Hung-Pin Tu, Chih-Hung Lee

    Roles Conceptualization, Data curation, Project administration, Supervision, Writing review & editing

Emerging Authors In Dermatology

CV Comorbidities Associated With Pediatric Psoriasis in ...

The editors of JCAD are pleased to present this biannual column as a means to recognize select medical students, PhD candidates, and other young investigators in the field of dermatology for their efforts in scientific writing. We hope that the publication of their work encourages these and other emerging authors to continue their efforts in seeking new and better methods of diagnosis and treatments for patients in dermatology.

Psoriasis is a chronic, immune-mediated, inflammatory, multisystem disease that affects about two percent of the adult population. In addition to its effects on the skin, psoriasis is associated with several comorbidities, including cardiovascular disease , metabolic syndrome , psoriatic arthritis , depression, Crohns disease, ulcerative colitis, drug-induced nephrotoxicity, chronic kidney disease, and nonalcoholic fatty liver disease . Therefore, patients with psoriasis often have higher mortality and hospitalization rates than those of the general population.

NAFLD is another disease associated with psoriasis and ranges from simple steatosis to cirrhosis. It is thought that the chronic inflammation in psoriasis, caused by proinflammatory adipokines or skin-derived cytokines, can trigger NAFLD by increasing insulin resistance and leading to hepatic lipid accumulation.

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World Psoriasis Day : From Symptoms To Risk Of Comorbidities All You Need To Know

World Psoriasis Day is marked in more than 50 countries today and is organised by the International Federation of Psoriatic Disease Associations

Every year, World Psoriasis Day is marked on 29 October to raise awareness about the medical condition and its effects.

Every year, World Psoriasis Day is marked on 29 October to raise awareness about the medical condition and its effects. About 125 million people globally are affected by psoriasis or psoriatic arthritis, an autoimmune condition that results in the rapid build-up of skin cells, which can also lead to severe comorbidities.

Contrary to common perception, the medical condition is not a non-contagious skin disease, but an autoimmune one where the cells responsible for maintaining the immune system mistakenly attacks it.

World Psoriasis Day is marked in more than 50 countries today and is organised by the International Federation of Psoriatic Disease Associations . Most diagnoses of the disease occur in adulthood, with the average onset being between the ages of 15 and 35 years.

What are the symptoms of psoriasis?

The symptoms of psoriasis include raised, inflamed patches of skin as well as soreness, itching and burning sensations around the patches. The disease also leads to whitish-silver scales on inflamed patches, swollen and painful joints and thick, pitted nails.

Most patients undergo cycles of the medical condition, with the symptoms flaring up and reducing again and again.


Pediatric Psoriasis Comorbidity Screening Guidelines

Although we can draw inferences from our experiences with pediatric patients.

preterm infants be screened for nephrocalcinosis? a screening program should have proven benefits with minimal.

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All patients should be screened for latent TB in accordance with national guidelines prior to starting.

of pre-existing disease. 27-30 Psoriasis Reports of new onset of psoriasis or.

May 30, 2017 · The National Psoriasis Foundation has guidelines for comorbidity screening in adults with psoriasis, but no guidelines previously existed for children, wrote Emily Osier, MD, of Eastern Virginia Medical School, Norfolk, and her colleagues .

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FC could be used to assess pouch inflammation instead of repeated endoscopies, especially in the pediatric setting and to evaluate mucosal integrity during infliximab therapy after surgery for CD.

View osier2017.pdf from FREN 1A at San Jose State University. Clinical Review & Education JAMA Dermatology | Consensus Statement Pediatric Psoriasis Comorbidity Screening Guidelines Emily Osier, MD

Psoriasis guidelines from the Academy of Dermatology stated that for mild disease, topical therapies are the mainstay as either monotherapy or in combination. For moderate to severe disease, topical therapies are commonly used in conjunction with.


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Symptoms Of Psoriatic Arthritis And Kidney Disease

Psoriatic arthritis sometimes develops in patients with psoriasis, an autoimmune skin condition that causes red, itchy, scaly, and inflamed plaques on the skin. Psoriatic arthritis is characterized by joint pain, inflammation, and stiffness.

The widespread inflammation that affects the skin and joints in psoriatic arthritis can also extend to other areas of the body, causing:

  • Nail changes
  • Swollen fingers or toes with a sausage-like appearance
  • Inflammation of the eyes
  • Inflammation of the sites where tendons and ligaments attach to bone

Other systemic symptoms can include chronic fatigue, digestive symptoms, such as abdominal pain, bloating, constipation, and diarrhea, and organ damage from inflammation of the heart, lungs, or kidneys.

With kidney disease, because toxic byproducts are not effectively being filtered out of the blood, increased inflammation throughout the body can manifest in several ways, including:

  • Fatigue

Panarteriitis Nodosa And Giant Cell Arteriitis

Managing Hypertension in Patients with Comorbidities

Vasculitic involvement of intermediate-sized and large vessels in panarteriitis nodosa and giant cell arteriitis, respectively, may occasionally lead to renal functional impairment . Inflammation and formation of microaneurysms in arteries of the renal parenchyma in panarteriitis nodosa or vasculitic stenosis of renal arteries and their branches in giant cell arteriitis will lead to chronic renal hypoperfusion and ischemia. Without involvement of the small glomerular capillaries these present clinically as progressive renal impairment and albuminuria, usually without gross hematuria and leukocyturia on urinalysis. Imaging studies rather than renal biopsy are required to confirm the diagnosis.

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Psoriasis Severity Linked To Increased Comorbid Presence Of Kidney Liver And Pancreatic Diseases

Written byDevon AndrePublished onJune 23, 2016

Psoriasis severity is linked to an increased comorbid presence of kidney, liver, and pancreatic diseases. In the study published in JAMA Dermatology, the researchers uncovered that psoriasis severity measured by the percentage of the affected body surface is strongly associated with a higher risk of comorbidities, including those that affect the lungs, liver, kidney, heart, and pancreas.

The researchers surveyed general practitioners caring for psoriasis patients. They found significant correlations between psoriasis severity and other conditions like COPD, diabetes, mild liver disease, myocardial infarction and peripheral vascular disease, peptic ulcer disease, renal disease, and other rheumatologic diseases.

Study author Joel M. Gelfand said, As we identify additional diseases linked to psoriasis, patients and physicians need to be aware of the increased odds of serious comorbid illnesses, which is especially important in severe cases. The complications from diabetes and links to COPD, kidney disease, and peptic ulcers we identified suggest new areas for research, while for the first time, demonstrating how increasing body surface area affected by psoriasis is directly associated with increasing risk of atherosclerotic disease.

How To Diagnose And Monitor Renal Co

Renal co-morbidity may not be apparent in terms of signs and symptoms, so functional parameters must be routinely measured. Serum creatinine is the most commonly used parameter for renal excretory function and is therefore used to predict the GFR for example, by applying the Modification of Diet in Renal Disease formula. Nowadays, the estimated GFR defines the stage of chronic kidney disease and most laboratories routinely report the estimated GFR along with serum creatinine results . The Modification of Diet in Renal Disease formula as well as other formulas used for GFR prediction, however, have not been validated to reliably predict GFR in patients with rheumatic diseases. In fact, the Modification of Diet in Renal Disease formula may underestimate renal function in patients with rheumatoid arthritis or with lupus nephritis . Concomitant elevations of blood urea nitrogen and uric acid imply renal excretory failure but only at an advanced stage of kidney damage.

Table 1 Renal functions and related clinical or laboratory parameters

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Study Design And Data Source

We conducted a population based cohort study using The Health Improvement Network , an electronic medical records database maintained by general practitioners in the United Kingdom. THIN is broadly representative of the general UK population and contains diagnostic, treatment, and laboratory data on over nine million individuals. In the UK, almost all patients are registered with a general practitioner who serves as the primary contact for healthcare and records data on diagnoses, prescriptions, and laboratory results as part of the patients electronic medical record. THIN has been widely used for epidemiological research and has been previously validated for the study of psoriasis, chronic kidney disease, and other diagnoses.161718 Data in this study were collected prospectively from 2003 to September 2010. The study was conducted in accordance with the STROBE statement.19

Pathogenesis Of Chronic Plaque Psoriasis And Its Intersection With Cardio

  • 1Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
  • 2Laboratory of Experimental Immunology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy

Psoriasis is a chronic, systemic immune-mediated disease characterized by development of erythematous, indurated, scaly, pruritic plaques on the skin. Psoriasis is frequently associated to comorbidities, including psoriatic arthritis, cardiovascular diseases, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and inflammatory bowel diseases. In this review, we discuss the pathophysiological relationship between psoriasis and cardio-metabolic comorbidities and the importance of therapeutic strategies to reduce systemic inflammation in patients with moderate-to-severe psoriasis. Pathogenesis of psoriasis and its comorbidities share both genetic predisposition and inflammatory pathways, which include the TNF and the IL-23/IL-17 pathways. These pathways are selectively addressed by biological treatments, which have substantially changed the outcomes of psoriasis therapy and affect positively comorbidities including reducing cardiovascular risk, allowing a more comprehensive approach to the patient.

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Comparison With Existing Literature

A small number of studies have measured the burden of comorbidity in CKD however, to the best of the authors knowledge, no existing studies have included a control population. Fraser et al examined comorbidity in a smaller population of 1741 people with CKD stage 3, and looked at the prevalence of a smaller number of comorbidities, which were not divided into concordant or discordant relationship with CKD. The study reported that comorbidity was seen in 96% of those with CKD, and 40% of those with CKD had 2 comorbidities.

Pathogenesis Behind The Comorbidities In Psoriasis

The pathogenesis behind psoriasis comorbidity remains partially unknown however different factors may be involved, including common pattern of immune responses and inflammatory pathways, shared risk factors, and genetic predisposition .

Figure 2 Genetic and environmental factors predispose to psoriasis and obesity. Obesity is a risk factor for both psoriasis and metabolic syndrome. However, inflammation associated with moderate to severe psoriasis can in turn favor insulin resistance, dyslipidemia, obesity, and non-alcoholic fatty liver disease , hence directly and/or indirectly fuelling atherosclerosis, and configuring the so-called psoriatic march. Ultimately, moderate to severe psoriasis directly and indirectly increases the risk of cardiovascular diseases and mortality. Psoriasis also precedes the development of psoriatic arthritis.

Patients with psoriasis are enriched for certain common genetic variants that predispose to increased risk of dyslipidemia, hypertension, and CVD .

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What Is Psoriatic Arthritis

Psoriatic arthritis is an inflammatory type of arthritis that develops in some people with psoriasis, an autoimmune disease that causes itchy, scaly plaques on the skin. Psoriasis affects 74 million adults in the United States, and 30% of patients diagnosed with psoriasis will develop psoriatic arthritis.

PsA causes inflammation in many joints of the body as a result of the body producing autoantibodies that attack healthy joints by mistake. This results in joint pain, inflammation, and stiffness, in addition to symptoms of the skin for some.

No Relation Between Psoriasis And Renal Abnormalities: A Case

Topical Therapy to Treat Plaque Psoriasis

Nikoo Mozafari

1Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2Internal Medicines Ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Academic Editor:


Multiple observational studies have demonstrated that psoriasis is associated with nephropathy however, the renal involvement in psoriasis remains largely a matter of debate. The current study was designed to investigate if psoriatic patients are at increased risk of renal abnormalities, in absence of any other comorbidities. Forty patients with moderate to severe chronic plaque type psoriasis who were not under systemic therapy and 40 age- and gender-matched control subjects were enrolled in the study. Patients and controls with history of diabetes, hypertension, and chronic renal disease were excluded. Urinalysis by dipstick and microscopic evaluation and 24h proteinuria and albuminuria were measured in all patients and controls. Patients with psoriasis and controls were not significantly different with respect to the prevalence of abnormal urinalysis , mean 24h proteinuria , and albuminuria . The presence of abnormal urinalysis was not more common in patients with psoriasis than in controls. Our study demonstrated that psoriatic patients without any other comorbidities are not at increased risk of kidney disease.

1. Introduction

2. Material and Methods

Microscopic hematuria was defined as 5 erythrocytes/HPF . All abnormal urinalyses were performed twice.

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Psoriasis And Your Risk For Other Conditions

As an autoimmune inflammatory condition, psoriasis shares a link with other systemic conditions like diabetes, metabolic syndrome, heart disease, stroke, and high blood pressure based on a shared underlying cause.

It is believed that these conditions result from chronic inflammation throughout the body caused by the activation of T-cells, a type of white blood cell involved in immune system responses, and specific cytokines .

How Does Psoriasis Affect The Risk For Chronic Kidney Disease

Severe psoriasis was associated with a greatly increased risk of chronic kidney disease in a recent study of more than 800,000 patients, including 142,883 with psoriasis, 7354 with severe psoriasis, and 689,702 without psoriasis. After adjustment for age, sex, cardiovascular disease, diabetes mellitus, hyperlipidemia, hypertension, use of nonsteroidal anti-inflammatory drugs, and body mass index, the adjusted hazard ratio for CKD among patients with severe psoriasis was 1.93.

In a nested analysis of 8731 psoriasis patients and 87,310 controls, the odds ratio of CKD after adjustment for age, sex, cardiovascular disease, diabetes, hypertension, hyperlipidemia, body mass index, use of nonsteroidal anti-inflammatory drugs, and duration of observation was 1.36 in patients with moderate psoriasis and 1.58 in those with severe psoriasis. The relative risk for CKD was highest in younger patients.

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