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. 2022 Feb;105(2):130-136.
doi: 10.1016/j.jdermsci.2022.02.004. Epub 2022 Feb 4.

Racial differences in dysregulation of the renin-angiotensin-aldosterone system in patients with prurigo nodularis

Nishadh Sutaria  1 , Melika Marani  1 , Justin Choi  1 , Youkyung Sophie Roh  1 , Varsha Parthasarathy  1 , Junwen Deng  1 , Zachary A Bordeaux  1 , Matthew T Taylor  1 , Kevin K Lee  1 , Thomas Pritchard  1 , Ali Alajmi  1 , Waleed Adawi  1 , Yevgeniy R Semenov  2 , Martin P Alphonse  1 , Shawn G Kwatra  3
Affiliations

Racial differences in dysregulation of the renin-angiotensin-aldosterone system in patients with prurigo nodularis

Nishadh Sutaria et al. J Dermatol Sci. 2022 Feb.

Abstract

Background: There are limited data characterizing the association between renal disease and prurigo nodularis (PN).

Objective: To characterize the association and describe mechanistic disease linkages between PN and renal comorbidities.

Methods: We conducted a cross-sectional analysis of renal comorbidities in PN using TriNetX, a global health research network providing access to medical records. Epidemiological findings provided the basis for translational studies on plasma and skin biopsy samples from PN patients stratified by race.

Results: PN was associated with stages 1-5 of chronic kidney disease (CKD), end-stage renal disease, nephritic syndrome, nephrotic syndrome, glomerular disease, and tubulointerstitial disease, but the associations were significantly stronger in black patients. Compared to controls, CKD progression was faster (HR 2.88, 95% CI: 1.01-8.26) only in black PN (10-year survival: 63.5% black vs. 85.5% white). Circulating plasma angiotensinogen levels were dysregulated (P < 0.001) only in black PN patients. Cutaneous transcriptomic analysis of genes related to the renin-angiotensin-aldosterone system (RAAS) revealed considerable dysregulation in PN lesions with greater dysregulation in black patients.

Conclusions: Significant dysregulation of the cutaneous and systemic RAAS in black PN patients may explain the increased incidence and severity of renal disease.

Keywords: Comorbidities; Itch; Prurigo nodularis; Pruritus; Racial; Renin-angiotensin-aldosterone system.

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Conflict of interest statement

Conflicts of interest Dr. Kwatra is an advisory board member/consultant for Abbvie, Celldex Therapeutics, Galderma, Incyte Corporation, Pfizer, Regeneron Pharmaceuticals, and Kiniksa Pharmaceuticals and has served as an investigator for Galderma, Kiniksa Pharmaceuticals, Pfizer Inc., and Sanofi. Dr. Semenov is a consultant for Castle Biosciences and Incyte Corporation. All other authors report no conflicts of interest.

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