A rare case of Uremic Frost in end-stage Kidney disease

Dr.Joana M. Martins and Dr.Rita Magriço, Hospital Garcia de Orta, Lisbon, Portugal have reported a case of Uremic Frost in End-Stage Renal Disease. The case has appeared in NEJM.

Uremic frost is a colloquial description for crystallized urea deposits that can be found on the skin of those affected by chronic kidney disease. This condition is more common in severe, untreated uremia and is associated with serum BUN levels >200. It is becoming rare in people with chronic kidney disease managed on long-term hemodialysis, with an estimated prevalence between 0.8 and 3%. It is usually associated with severe azotemia and results from crystallization of urea on the skin after sweat evaporates. In other words, it is an uncommon dermatologic manifestation of profound azotemia

As the history goes A 39-year-old man presented to the emergency department with anorexia, nausea, vomiting, and oliguria.

He was a known case of End-stage Renal Disease and five months earlier, he had stopped attending his regular hemodialysis sessions. He reported that he had thought that the dialysis sessions were no more needed because he continued to have urine output. When examined, his blood pressure was 167/80 mm Hg.

Courtesy NEJM

The doctors found that he was lethargic and had slowed speech and oedema of the legs. His breath had a urine-like odour and his skin had diffuse crystalline white deposits that were distributed mainly on his face, abdomen, and arms. The laboratory studies revealed a blood urea nitrogen level of 231 mg per deciliter (82.5 mmol per litre), a creatinine level of 20.0 mg per deciliter (1770 μmol per liter), a sodium level of 125 mmol per litre, and a potassium level of 7.7 mmol per litre. The patient was subjected to immediate hemodialysis.

The patient improved drastically with an improvement of his symptoms of lethargy as he resumed regular hemodialysis sessions.He had complete regression of the uremic frost at 2 weeks after presentation.

Reference,

https://www.nejm.org/doi/full/10.1056/NEJMicm1716367