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Kidney disease: 11 ways it can affect your skin

If you have kidney disease, you won’t see early warning signs on your skin. However, as the disease
progresses, you may develop one or more of the following:

1. Extremely dry skin. Skin can become so dry that it:

Becomes rough and scaly

Feels tight and cracks easily
Develops fish-like scales
Extremely dry skin is common in people who have end-stage kidney disease, which requires dialysis
or a kidney transplant.

2. Itchy skin. Extremely itchy skin is a common symptom of advanced kidney disease. The itch can
range from irritating to life-disrupting. Your skin may itch all (or most of) the time.

Some people have itch on one area of their skin. The itch can also spread across most of your body.

3. Scratch marks and other signs of scratching. When you scratch often, it affects your skin. You can
develop:

Raw, bleeding skin or sores

Thick, leathery skin (lichen simplex chronicus)
Firm, very itchy bumps (nodularis prurigo)
If nothing seems to relieve the itch, you may want to see a dermatologist. Some people who have end-
stage kidney disease get relief from a treatment called UVB phototherapy.

4. Color changes to your skin. When the kidneys stop working as they should, toxins build up in your
body. This build-up can cause color changes to the skin. You may see any of the following:

An unhealthy pale color

Gray hue
Yellowish color
Areas of darkened skin, as shown here
Yellowish, thick skin with bumps and deep lines
Cysts and spots that look like whiteheads
The last two develop when you’ve had itchy skin for a long time and scratch often.

5. Nail changes. Kidney disease can affect the appearance of your fingernails, toenails, or both. People
who have advanced kidney disease can develop:

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 A white color on the upper part of one or more nails and a normal to reddish brown color below,
as shown here (half-and-half nails)
Pale nails
White bands running across one or more nails (Muehrcke’s nails)
Because your nails reveal a lot about your health, see your doctor if you notice any changes to your
fingernails or toenails.

6. Swelling. Your kidneys remove extra fluids and salt from your body. When they can no longer do this,
the fluids and salt build up in your body. This build-up causes swelling, which you may notice in your:

Legs
Ankles
Feet
Hands
Face
You may see the swelling in one or several areas of your body.

7. Rash. When kidneys cannot remove waste from your body, a rash can develop. One rash that occurs
in people who have end-stage kidney disease causes small, dome-shaped, and extremely itchy
bumps. As these bumps clear, new ones can form. Sometimes, the small bumps join together to form
rough, raised patches.

8. Blisters. Some people who have end-stage kidney disease develop blisters, which can form on their:

Hands (as shown here)

Face
Feet
The blisters will open, dry up, and crust over. As they clear, scars appear.

9. Lump in your belly. This can be a sign of kidney cancer. In its early stages, kidney cancer seldom
causes symptoms. When the cancer advances, it can cause a mass or lump on the:

Side
Belly
Lower back
Feeling a mass in one of these areas can also be a sign of something less serious going on inside
your body. If you find any spot or lump, make an appointment to see your doctor.

10. Skin too tight to pinch. This is an extremely rare side effect that can occur when you get an MRI or
another test that requires a contrasting agent. A doctor may request a contrast agent to get a better
view inside an area of your body, such as a blood vessel. If you need a contrasting agent, it will be
injected into a vein before your test.

Gadolinium is a contrasting agent that can affect your kidneys. When this happens, it can cause:

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 Areas of hard, shiny skin that become too tight to pinch
Inability to fully bend a knee, elbow, or other part of your body
Skin that feels bound down
This is a rare side effect. If you have kidney disease, be sure to tell any doctor who orders a medical
test for you.

11. Calcium deposit under the skin. Your kidneys have several jobs. One is to balance certain minerals
in your blood, such as sodium and phosphate. When the kidneys cannot maintain a healthy balance,
levels can rise. Some people develop deposits of calcium in their skin, such as the patient in this
picture. This patient also has half-and-half nails, which is another sign of kidney disease.

Calcium deposits usually develop around a joint and are not painful. However, when they occur within
a fingertip, they can cause a great deal of pain.

If one of these deposits pushes up through the skin, you may see a chalky discharge.

How to find kidney disease before it affects your skin

The most common form of kidney disease is chronic kidney disease (CKD). It develops when kidneys
become permanently damaged. About 37 million people are estimated to have CKD, and most don’t know
they have it, according to the Centers for Disease Control (CDC).1

You can find kidney disease in an earlier stage (before permanent damage occurs) by seeing your primary
care doctor. Blood and urine tests can tell your doctor how well your kidneys are working.

These tests are extremely important if you have:

Diabetes

High blood pressure

Anyone who is 65 years of age or older should also be screened for kidney disease.

How dermatologists help patients with kidney disease

Kidney doctors, called nephrologists, often care for patients with kidney disease. When a kidney disease
affects the skin, a nephrologist may team up with a dermatologist. Some skin conditions that develop due to
kidney disease can be difficult to control. For example, if a patient has extremely itchy skin, it may be
impossible to sleep through the night. A board-certified dermatologist can help a patient get some relief. This
may involve using the right balance of moisturizers and medication that you apply to the skin. Some patients
get relief with a treatment called UVB phototherapy.

The right skin care may also help. If the kidney disease is causing extremely dry skin, these tips from
dermatologists may help:

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Self-care: Dry skin

1 Centers for Disease Control and Prevention. “Chronic kidney disease in the United States, 2019.” Page last reviewed Mar. 11,
2019. Last accessed Feb. 27, 2020.

Images
Image 1: Image used with permission of the American Academy of Dermatology National Library of
Dermatologic Teaching Slides.

Images 2, 3, 6, 9, 10: Getty Images

Images 4, 5, 7, 8, 11: Journal of the American Academy of Dermatology

Image 4: Streams BN, Liu V, et al. “Clinical and pathologic features of nephrogenic fibrosing
dermopathy: a report of two cases.” J Am Acad Dermatol. 2003;48(1):42-7.

Image 5: Saray Y, Seçkin D, et al. “Nail disorders in hemodialysis patients and renal transplant
recipients: a case-control study.” J Am Acad Dermatol. 2004;50(2):197-202.

Images 7, 8, 11: Robinson-Bostom L, DiGiovanna JJ. “Cutaneous manifestations of end-stage renal

disease.” J Am Acad Dermatol. 2000;43(6):975-86.

References
Amin A, Burgess EF. “Skin manifestations associated with kidney cancer.” Semin Oncol. 2016;43(3):408-12.

Centers for Disease Control and Prevention. “Chronic kidney disease in the United States, 2019.” Page last
reviewed Mar. 11, 2019. Last accessed Feb. 27, 2020.

Galperin TA, Cronin AJ, et al. “Cutaneous Manifestations of ESRD.” Clin J Am Soc Nephrol. 2014;9(1):201-
18.

Girardi M, Kay J, et al. “Nephrogenic systemic fibrosis: Clinicopathological definition and workup
recommendations.” J Am Acad Dermatol 2011;65:1095-106.

Kobayashi TT. “Cutaneous manifestations of renal disease.” In: Fitzpatrick JE, et al. Dermatology Secrets
Plus (5th edition). Elsevier. China, 2016:340-7.

Robinson-Bostom L, DiGiovanna JJ. “Cutaneous manifestations of end-stage renal disease.” J Am Acad

Dermatol. 2000;43(6):975-86.

Saray Y, Seçkin D, et al. “Nail disorders in hemodialysis patients and renal transplant recipients: a case-
control study.” J Am Acad Dermatol. 2004;50(2):197-202.

Scheinfeld NS. “Nephrogenic systemic fibrosis.” Medscape. Posted May 22, 2018. Last accessed Feb. 27,
2020.

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Streams BN, Liu V, et al. “Clinical and pathologic features of nephrogenic fibrosing dermopathy: a report of
two cases.” J Am Acad Dermatol. 2003;48(1):42-7.

Van Amburgh JA. “How Is uremic pruritus treated?” Medscape Dermatology. Posted Feb 12, 2014. Last
accessed Feb 27, 2020.

Van de Velde-Kossmann KM, “Skin examination: An important diagnostic tool in renal failure patients.” Blood
Purif 2018;45:187–93.

Itchy skin

Scratch marks and other signs of scratching

Darkening skin on shins of legs

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Half white, half red nails on swollen fingers

Swollen feet and ankles

Rash: Small raised bumps on skin

Crusts on hands from blisters

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 Painful belly

Skin too tight to pinch

Calcium deposit under the skin

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