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Uremic Frost

      A 58-year-old man presented to the emergency department with acute urinary retention and abdominal pain. Laboratory tests revealed a serum creatinine level of 20 mg/dL and blood urea nitrogen of 263 mg/dL. A urinary catheter was placed and drained 2 L of urine. On examination, his skin was covered diffusely with a fine white powder known as “uremic frost” (Figure). These skin findings rapidly resolved over the next 48 hours with improvement of his severe uremia.
      Figure thumbnail gr1
      Figure“Uremic frost,” pictured here on the forearm, is a manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin, resulting in a frosted appearance as sweat evaporates.
      Uremic frost is a manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin, resulting in a frosted appearance as sweat evaporates.
      • Johnston G.A.
      • Graham-Brown R.C.
      Chapter 150. The skin and disorders of the alimentary tract, the hepatobiliary system, the kidney, and the cardiopulmonary system.
      It is most frequently observed on areas of skin with eccrine glands and hair such as the scalp, neck, face, forearms, and chest and can be easily wiped away.
      • Saardi K.M.
      • Schwartz R.A.
      Uremic frost: a harbinger of impending renal failure.
      Uremic frost was first described by Hirschsprung in 1865
      • Kuo C.C.
      • Hung J.B.
      • Tsai C.W.
      • Chen Y.M.
      Uremic frost.
      but is now a rarely observed physical examination finding in settings in which hemodialysis is readily available. Among 9 cases of uremic frost published in the literature, the mean blood urea nitrogen was 199 mg/dL and the mean serum creatinine level was 17.5 mg/dL.
      • Saardi K.M.
      • Schwartz R.A.
      Uremic frost: a harbinger of impending renal failure.
      Although a rare finding, uremic frost remains an important sign of severe renal failure, particularly in clinical settings with limited resources.

      References

        • Johnston G.A.
        • Graham-Brown R.C.
        Chapter 150. The skin and disorders of the alimentary tract, the hepatobiliary system, the kidney, and the cardiopulmonary system.
        in: Goldsmith L.A. Katz S.I. Gilchrest B.A. Paller A.S. Leffell D.J. Wolff K. Fitzpatrick's Dermatology in General Medicine. 8th ed. McGraw-Hill, New York, NY2012
        • Saardi K.M.
        • Schwartz R.A.
        Uremic frost: a harbinger of impending renal failure.
        Int J Dermatol. 2016; 55: 17-20
        • Kuo C.C.
        • Hung J.B.
        • Tsai C.W.
        • Chen Y.M.
        Uremic frost.
        CMAJ. 2010; 182: E800