Cutaneous Mast Cell Quantity in Pruritic and Nonpruritic Hemodialysis Patients

Abstract

Pruritus remains a significant complication of end-stage renal disease. Its cause in hemodialysis patients is not known. It has been postulated that increased numbers of mast cells occur in these patients and may account for the presence of pruritus. Our objective was to determine if there is a difference in the number of cutaneous mast cells between pruritic and nonpruritic patients. A 3-mm punch biopsy specimen was obtained from pruritic (n = 7) and nonpruritic (n = 6) hemodialysis patients. We observed no significant difference in the quantity of cutaneous mast cells in pruritic and nonpruritic hemodialysis patients. We conclude that the etiology of pruritus in hemodialysis patients is not related to an increase in the number of cutaneous mast cells.

A randomized controlled trial of high-permeability haemodialysis against conventional haemodialysis in the treatment of uraemic pruritus

“…9 The mechanisms of UP are still unclear; however, many molecules that are abnormally accumulated in patients with ESRD have been implicated in the pathogenesis of itching. 12,13 This is consistent with our observation that haemodialysis has the ability to relieve UP through the clearance of accumulated substances. Histamine is a well-known pruritogen and can directly stimulate the neurone terminals by H1 receptors.…”

“…In addition to histamine, high serum levels of small molecule substances such as Ca 2+ , PO 4 3) , Mg 2+ , raised skin content of divalent ions, and hypervitaminosis A have been also inconclusively considered as linked to the presence of pruritus in patients with ESRD. 12,13 This is consistent with our observation that haemodialysis has the ability to relieve UP through the clearance of accumulated substances.…”

Uremic pruritus: A review

“…An anatomic abnormality in the pattern of the enolase‐positive fibers was reported to be present in pruritic ESRD patients, 28 but this has not been further substantiated 29 . Numbers of skin mast cells and serum levels of histamine are increased in uremic patients but this seems to occur irrespective of the presence of pruritus 27,30 . Additional factors have been inconclusively implicated with the presence of pruritus in ESRD patients including high serum levels of Ca, P, Mg, PTH, aluminum, and substance P; elevated cutaneous content of divalent ions; hypervitaminosis A; and peripheral neuropathy 25,27 , 31,32 .…”

“…29 Numbers of skin mast cells and serum levels of histamine are increased in uremic patients but this seems to occur irrespective of the presence of pruritus. 27,30 Additional factors have been inconclusively implicated with the presence of pruritus in ESRD patients including high serum levels of Ca, P, Mg, PTH, aluminum, and substance P; elevated cutaneous content of divalent ions; hypervitaminosis A; and peripheral neuropathy. 25,27,31,32 More recently, a substantial body of evidence has been accumulated in favor of the concept that the uremic state is a chronic inflammatory condition in which a number of proinflammatory cytokines are activated.…”

Uremic Pruritus: A Review

“…A role for hista mine has recently been relaunched by Stockenhuber et al [36] , who found increased plasma histamine levels in HD patients with pruritus compared to those without pruritus. Others, however, could not find any difference in plasma histamine levels between pruritic and nonpruritic patients [24], as well as between patients on HD or CAPD [37], It would be possible that uremic pruritus is caused by an abnormal histamine reactivity. Stahle-Backdahl [28] showed that the itch responses in uremic patients with pruritus were significantly greater than in nonpruritic urem ics or controls, indicating an increased sensitivity to pruritogenic stimuli.…”