Počki (Oct 2019)
Psoriatic nephropathy: the nature, manifestation spectrum and evidence of kidney damage in psoriasis
Abstract
Psoriasis is a chronic inflammatory disease characterized by a high degree of comorbidity, foremost cardiovascular disease, diabetes mellitus, obstructive pulmonary disease, arterial hypertension, and arthritis. This comorbidity is most expressed in young patients and in severe forms of the disease. Recent studies indicate a link between psoriasis and kidney damage. This association is caused by the autoimmune inflammatory processes being the main pathogenetic links in the development of psoriasis. It can cause glomerular damage, leading to subclinical glomerular dysfunction. The kidney is also a target organ for classical cardiovascular risk factors and cardiovascular diseases, the incidence of which is significantly increased in patients with psoriasis. Besides, some medications used to treat psoriasis are nephrotoxic. Psoriatic arthritis and non-steroidal anti-inflammatory drug use may increase the risk of kidney damage in patients with psoriasis. Thus, three possible associations of kidney damage with psoriasis are distinguished: immune-mediated kidney damage, chronic kidney damage associated with comorbidities and drug-induced kidney damage. In this literature review, we would like to draw readers’ attention to this recently described concomitant pathology and emphasize the importance of early detection of chronic kidney disease in patient with psoriasis, since this process is irreversible. In the management of patients with psoriasis, especially in cases of systemic therapy, it is necessary to regularly monitor the glomerular filtration rate, common urine analysis and the degree of albuminuria. Particular caution should be marked in severe forms of psoriasis and concomitant psoriatic arthritis, since in these cases the risk of psoriasis-associated nephropathy development increases significantly.
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