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Scleromyxedema‐like lesions of patients in renal failure contain hyaluronan: a possible pathophysiological mechanism
Author(s) -
Neudecker Birgit A.,
Stern Robert,
Mark Leslie A.,
Steinberg Steven
Publication year - 2005
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2005.00415.x
Subject(s) - pathology , medicine , dermis , clearance , kidney , pathophysiology , urology
Background: Patients with renal failure have been identified recently, some on dialysis, others with renal transplants, who have scleromyxedema‐like skin changes. These lesions are characterized grossly by extensive thickening of skin, brawny pigmentation, papules, and subcutaneous nodules. Mucinous deposits are observed histologically that resemble those in scleromyxedema. Methods: Biopsies of these lesions were stained with a biotinylated hyaluronan (HA)‐binding protein coupled to an avidin‐peroxidase reaction. Results: These lesions are associated with marked deposition of HA in the papillary dermis. Conclusions: HA turnover is cleared rapidly in the circulation by both liver and kidney. Evidence suggests that high molecular size HA chains, which are anti‐inflammatory, antiangiogenic, and immuno‐suppressive are cleared by the liver. By contrast, intermediate‐size fragments, which are highly angiogenic, inflammatory, and a stimulus for fibrous deposition, are cleared by the kidney. The accumulation of such fragments in renal failure can account for HA deposition in the dermis and may be a mechanism for the nephrogenic fibrosing dermopathy that can accompany these lesions.