Uremic Pruritus and Skin Mast Cells

Dimković, Nada; Djukanović, Ljubica; Radmilović, A; Bojić, P; Juloski, Todor

doi:10.1159/000186826

Cited by 66 publications

(46 citation statements)

References 10 publications

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“…2,7,13 Sel mast tersebar secara difus di sepanjang kulit dan sebagian besar berdegranulasi. 9,16 Sel mast pada dermis terletak berdekatan ke saraf aferen C neuron terminal, dan interaksi antara struktur ini berperan penting dalam mediasi pruritus. 7 Sel mast akan melepaskan berbagai substansia seperti histamin, protease, interleukin-2, dan tumor necrosis factor.…”

Section: Patogenesisunclassified

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Pruritus Uremik

Pardede¹

2016

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Pruritus uremik adalah pruritus yang terjadi pada gagal ginjal yang disebabkan oleh toksin uremik, dengan prevalensi berkisar antara 20%-50%.. Pruritus uremik dapat mengganggu aktivitas atau pekerjaan, mengganggu tidur, dan menurunkan kualitas hidup. Patogenesis pruritus uremik masih belum jelas, tetapi ada kaitannya dengan hiperparatiroidisme, hormon parathormon, metabolisme kalsium dan fosfor, inervasi kulit abnormal, neuropati somatik, peningkatan kadar histamin, dan reseptor opioid. Faktor neurofisiologik memegang peran penting dalam terjadinya pruritus. Patogenesis yang sering diajukan adalah the immunohypothesis dan hipotesis opioid. Berdasarkan hipotesis ini, berbagai jenis pengobatan dilakukan untuk menanggulangi pruritus uremik. Meskipun tata laksana pasien penyakit ginjal stadium akhir sudah berkembang pesat, namun tata laksana pruritus masih merupakan masalah klinis. Pengobatan dapat dilakukan secara topikal dengan menggunakan salep seperti capsaicin atau takrolimus. Pengobatan sistemik telah dicoba dengan naltrekson, agonis reseptor -opioid, dan nalfurafin, agonis reseptor -opioid. Selain itu perlu diperhatikan terapi suportif lainnya seperti menciptakan suasana yang sejuk. (Sari Pediatri 2010;11(5):348-54).

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Section: Patogenesisunclassified

“…7 Sel mast akan melepaskan berbagai substansia seperti histamin, protease, interleukin-2, dan tumor necrosis factor. 7,16 Histamin telah dikenal luas sebagai pruritogenik yang secara langsung menstimulasi neuron terminal oleh reseptor H1.…”

Section: Patogenesisunclassified

Pruritus Uremik

Pardede¹

2016

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“…The use of PMMA membranes has been shown to ameliorate the severity and frequency of pruritis [95] in HD patients due to adsorption of a 160,000 Dalton molecular weight molecule with stimulatory effect on mast cells [100]. PMMA membranes also efficiently adsorb β 2 -M (representative of middle molecules), where they have been shown to improve carpal tunnel syndrome or total joint pain score in HD patients [99].…”

Section: Adsorption Hemodialysismentioning

confidence: 99%

Advances in Hemodialysis Techniques

Karkar¹

2013

Hemodialysis

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“…Plasma histamine levels were found to be increased in uremic patients, mainly in those with pruritus [5, 7, 8, 11, 15, 16], and some investigators have found a positive correlation between plasma histamine levels and pruritus [7, 8, 11, 15, 16], but this was not confirmed by others [5]. Serotonin has been reported to be a mediator of uremic pruritus – it causes itching when injected with prostaglandins –, and the results with the use of ketotifen, a stabilizer of mast cell membrane, in patients with uremic pruritus are encouraging [15, 16].…”

Section: Introductionmentioning

confidence: 99%

“…Serotonin has been reported to be a mediator of uremic pruritus – it causes itching when injected with prostaglandins –, and the results with the use of ketotifen, a stabilizer of mast cell membrane, in patients with uremic pruritus are encouraging [15, 16]. Also ondansetron, a potent and selective inhibitor of 5-HT 3 receptors in the central and peripheral neural systems, has been used in some patients with severe pruritus due to cholestasis of various etiology, with satisfactory results [17, 18].…”

Section: Introductionmentioning

confidence: 99%

Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

Balaskas¹,

Bamihas²,

Karamouzis³

et al. 1998

Nephron

105

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Pruritus is a common, unpleasant symptom of uremic patients. Serotonin and histamine have been reported as possible mediators of uremic pruritus, and ondansetron is a potent and selective inhibitor of 5-HT₃ receptors. The aims of our study were (1) to evaluate the effect of ondansetron on uremic pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients and its safety and (2) to investigate the role of histamine and serotonin in uremic pruritus. To study the prevalence and pathogenesis of uremic pruritus, CAPD and hemodialysis (HD) patients were asked to complete a pruritus questionnaire. The replies were scored based on numerical scales, and the results were evaluated by the same investigator who did not know the patients. Pruritus was graded, according to the total points for each patient, as mild, moderate, or severe. Of 54 patients on HD, 29 (53.7%) had pruritus, and of 43 patients on CAPD, pruritus was present in 21 (48.8%). In HD patients, pruritus was mild in 14 (48.3%), moderate in 12 (41.4%), and severe in 3 (10.3%) patients; the distribution in CAPD patients was 9 (42.9%), 10 (47.6%), and 2 (9.5%), respectively. There was no correlation between the presence and severity of pruritus and age, sex, primary renal disease, duration of dialysis, dialysis solutions used, and hematological and biochemical parameters except for serum histamine and serotonin levels and their product. Plasma histamine levels in CAPD patients were 13.1 ± 1.1 ng/ml in pruritic and 11.0 ± 3.9 ng/ml in nonpruritic patients (p = 0.06), serum serotonin levels were 115.6 ± 43.3 ng/ml and 64 ± 42.3 ng/ml (p < 0.05), respectively, and the histamine × serotonin product was 1,461 ± 576 and 646 ± 545 (p < 0.01), respectively. Eleven CAPD patients (6 males, 5 females) with a mean age of 66 (range 33–83) years and an average time on CAPD of 18 (range 3–31) months with moderate to severe pruritus were treated with ondansetron (4 mg twice daily p.o.) for a mean period of 3 (range 1–5) months. All patients responded to the treatment. There was a significant reduction of the severity of pruritus from the start of treatment, and on the 3rd day the pruritic score (mean value) was 10 (range 5–19) points, while at time 0 (before treatment) it was 26 (range 19–37) points (p < 0.0001). Pruritus disappeared in 7 patients at the end of the 1st week and in all patients at the end of the 2nd week of treatment. This effect was maintained during the study. Plasma histamine levels decreased significantly during the treatment from 12.9 ± 1.2 to 6.7 ± 5.9 ng/ml (p < 0.05). Also, serum serotonin levels were reduced from 125.1 ± 47.8 to 59.3 ± 27.5 ng/ml (p < 0.05) at the end of the 1st month of treatment, and the histamine × serotonin product showed a more significant reduction: from 1,544 ± 656 to 454 ± 436 (p < 0.01). Three patients reported an improvement in their nausea and vomiting during the treatment. Weekly clinical and laboratory examinations showed no side effects, adverse reactions, or other complications. Our data indicate that o...

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Uremic Pruritus and Skin Mast Cells

Cited by 66 publications

References 10 publications

Pruritus Uremik

Pruritus Uremik

Advances in Hemodialysis Techniques

Histamine and Serotonin in Uremic Pruritus: Effect of Ondansetron in CAPD-Pruritic Patients

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