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Review
. 2023 Jan 13;24(2):1559.
doi: 10.3390/ijms24021559.

Pathogenesis and Treatment of Pruritus Associated with Chronic Kidney Disease and Cholestasis

Jin-Cheol Kim  1 , Won-Sik Shim  2 , In-Suk Kwak  3 , Dong-Hun Lee  4 , Jin-Seo Park  1 , So-Yeon Lee  1 , Seok-Young Kang  1 , Bo-Young Chung  1 , Chun-Wook Park  1 , Hye-One Kim  1
Affiliations
Review

Pathogenesis and Treatment of Pruritus Associated with Chronic Kidney Disease and Cholestasis

Jin-Cheol Kim et al. Int J Mol Sci. .

Abstract

Itching is an unpleasant sensation that provokes the desire to scratch. In general, itching is caused by dermatologic diseases, but it can also be caused by systemic diseases. Since itching hampers patients' quality of life, it is important to understand the appropriate treatment and pathophysiology of pruritus caused by systemic diseases to improve the quality of life. Mechanisms are being studied through animal or human studies, and various treatments are being tested through clinical trials. We report current trends of two major systemic diseases: chronic kidney disease and cholestatic liver disease. This review summarizes the causes and pathophysiology of systemic diseases with pruritus and appropriate treatments. This article will contribute to patients' quality of life. Further research will help understand the mechanisms and develop new strategies in the future.

Keywords: cholestasis; chronic kidney disease; pruritus; systemic disease.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The clinical images of patients with CKD-associated pruritus (A) Multiple excoriated, purple-colored nodules or plaques on the back. (B) Scaly, erythematous patches on the back. (C) Multiple excoriated, dome-shaped nodules on the trunk.
Figure 2
Figure 2
The mechanism of treatment for patients with uremic pruritus STAT3; Signal transducer and activator of transcription 3, GRP; Gastrin-releasing peptide, GRPR; Gastrin-releasing peptide receptor, LCN2; Lipocalin-2, NPRA; Natriuretic peptide receptor-A, NPPB; Natiurtetic polypeptide b, GABA; Gamma-aminobutyric acid, Bhlhb5; Basic helix-loop-helix B 5, TRPV1; Transient receptor potential vanilloid type 1, TRPM8; Transient receptor potential melastatin 8.
Figure 3
Figure 3
The treatment algorithm of cholestatic pruritus. Green: Treatment of bile duct obstruction; Red: inhibit bile acid synthesis or increase excretion (prevent reabsorption); Purple: opioid antagonist; Blue: improving overall liver function; Orange: regulation of neurotransmitters; Yellow: excretion and detoxification of pruritogens.
See this image and copyright information in PMC

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