Uraemic pruritus--new perspectives and insights from recent trials.

Uraemic pruritus (UP) remains a frequent and sometimes tormenting problem in patients with advanced or end-stage renal disease [1]. Many attempts have been made to relieve this bothersome symptom in affected patients, however with generally limited success. Whenever a new treatment option is reported to be effective, some time elapses before conflicting results are published; in the meantime, the mood of patients and physicians changes from euphoria to disillusionment. This happened with erythropoetin [2,3] and naltrexone [4,5], the last propagated treatment modalities in this respect. The main obstacle in the effort to create effective treatment modalities is the incomplete knowledge of the underlying pathophysiological mechanisms. Furthermore, given the great clinical heterogenicity of UP, systematically performed studies are hard to obtain and are therefore sparse.

[1]  T. Mettang,et al.  Short-Term Efficacy of Tacrolimus Ointment in Severe Uremic Pruritus , 2000, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[2]  A. Meyrier,et al.  In vivo intracellular cytokine production by leukocytes during haemodialysis. , 2000, Cytokine.

[3]  T. Kita,et al.  Altered Th1/Th2 commitment in human CD4+ T cells with ageing , 2000, Clinical and experimental immunology.

[4]  T. Risler,et al.  Naltrexone does not relieve uremic pruritus: results of a randomized, double-blind, placebo-controlled crossover study. , 2000, Journal of the American Society of Nephrology : JASN.

[5]  F. Gruijl,et al.  UVB exposure‐induced systemic modulation of Th1‐ and Th2‐mediated immune responses , 1999, Immunology.

[6]  D. Alling,et al.  Open‐label trial of oral nalmefene therapy for the pruritus of cholestasis , 1998, Hepatology.

[7]  B. Bromm,et al.  Skin testing of the pruritogenic activity of histamine and cytokines (interleukin‐2 and tumour necrosis factor‐α) at the dermal–epidermal junction , 1997, The British journal of dermatology.

[8]  D. Tarng,et al.  Uremic pruritus: roles of parathyroid hormone and substance P. , 1997, Journal of the American Academy of Dermatology.

[9]  D. Silverberg,et al.  Randomised crossover trial of naltrexone in uraemic pruritus , 1996, The Lancet.

[10]  D. Alling,et al.  Effects of Naloxone Infusions in Patients with the Pruritus of Cholestasis: A Double-Blind, Randomized, Controlled Trial , 1995, Annals of Internal Medicine.

[11]  N. Bergasa,et al.  The pruritus of cholestasis: potential pathogenic and therapeutic implications of opioids. , 1995, Gastroenterology.

[12]  A. Kuroiwa,et al.  Optimal dialysis improves uremic pruritus. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  C M Lockwood,et al.  The immunosuppressive drug thalidomide induces T helper cell type 2 (Th2) and concomitantly inhibits Th1 cytokine production in mitogen‐ and antigen‐stimulated human peripheral blood mononuclear cell cultures , 1995, Clinical and experimental immunology.

[14]  J. Buckner,et al.  Phase I Trial of Combined Recombinant Interleukin‐2 with Levamisole in Patients with Advanced Malignant Disease , 1994, American journal of clinical oncology.

[15]  M. Suthanthiran,et al.  Medical progress : renal transplantation , 1994 .

[16]  D. Alling,et al.  Cholestasis in the male rat is associated with naloxone-reversible antinociception. , 1994, Journal of hepatology.

[17]  J. Lugon,et al.  Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial. , 1994, Nephron.

[18]  N. Bergasa,et al.  Central mu-opioid receptors are down-regulated in a rat model of cholestasis. , 1992, Journal of hepatology.

[19]  E. Bartoli,et al.  Relief of pruritus and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia. , 1992, The New England journal of medicine.

[20]  L. Djukanovic,et al.  Uremic pruritus and skin mast cells. , 1992, Nephron.

[21]  F. Stockenhuber,et al.  Increased plasma histamine levels in uraemic pruritus. , 1990, Clinical science.

[22]  P. Fritz,et al.  Uremic pruritus in patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). The role of plasma histamine and skin mast cells. , 1990, Clinical nephrology.

[23]  L. Lins,et al.  Experimental and immunohistochemical studies on the possible role of parathyroid hormone in uraemic pruritus , 1989, Journal of internal medicine.

[24]  M. Losowsky,et al.  Opioid peptides and primary biliary cirrhosis. , 1988, BMJ.

[25]  A. Menter,et al.  Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy. , 1985, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  L. Andersen,et al.  Naloxone in the treatment of uremic pruritus: a case history. , 1984, Clinical nephrology.

[27]  L. Mather,et al.  Intrathecal and epidural administration of opioids. , 1984, Anesthesiology.

[28]  R. Stern,et al.  Clinical features of pruritus among patients undergoing maintenance hemodialysis. , 1982, Archives of dermatology.

[29]  S. Reiz,et al.  SIDE-EFFECTS OF EPIDURAL MORPHINE , 1980, The Lancet.

[30]  B. Gilchrest,et al.  ULTRAVIOLET PHOTOTHERAPY OF UREMIC PRURITUS , 1979, International journal of dermatology.

[31]  K. Arndt,et al.  Ultraviolet phototherapy of uremic pruritus. Long-term results and possible mechanism of action. , 1979, Annals of internal medicine.

[32]  A. Young,et al.  Dermatologic evaluation of pruritus in patients on hemodialysis. , 1973, New York state journal of medicine.

[33]  S. Massry,et al.  Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. Disappearance of itching after subtotal parathyroidectomy. , 1968, The New England journal of medicine.

[34]  M. Polley Renal transplantation. , 1967, Nursing times.