title: Differences in epidermal thickness and expression of apoptosis regulatory proteins in the skin of patients with chronic renal failure and pruritus.
abstract: Chronic renal failure is often associated with skin itching (pruritus) in dialysis patients. In order to investigate the possible causes of pruritus, the epidermis of the thigh of 12 dialysis patients and 4 controls from patients without renal disease were examined. The sections of the epidermis were measured and immunohistochemically analyzed using antibodies to Bcl-2, Bax, caspase-3 proteins and TUNEL method. While the mean thickness of normal epidermis was 53 μm, in dialysis patients it ranged between 23 and 34 μm during the 3-5 year period on dialysis. Compared to normal skin, the fine balance between the Bcl-2 and Bax proteins did not greatly change in the epidermis of dialysis patients during the three years of dialysis. Following five-year dialysis, the epidermis displayed increased Bax and decreased Bcl-2 expression in the basal and intermediate epidermal layers, as well as the presence of apoptotic cells (TUNEL and caspase-3 positive) both in the superficial and intermediate epidermal layers. Our study demonstrated the predominant expression of cell death Bax proteins over cell survival Bcl-2 proteins, and apoptotic cells in the deeper layers of the epidermis in patients on long-term dialysis. We speculate that the thinning of the epidermis might be associated with the appearance of dead cells in the deeper epidermal layers, while the changed internal milieu of epidermal cells could possibly affect the intra-epidermal nerve endings thus leading to the sensation of pruritus.
authors: Clinic of Dermatovenerology, School of Medicine, University of Split, Clinical Hospital Center Split, Split, Croatia.
authors: Lina Mirić
authors: LM
authors: Kovačević
authors: Neira
authors: N
authors: Puizina-Ivić
authors: Dragan
authors: D
authors: Ljutić
authors: Snježana Mardešić
authors: SM
authors: Brakus
authors: Danijela Kalibović
authors: DK
authors: Govorko
authors: Ivo
authors: I
authors: Jeličić
authors: Dino
authors: D
authors: Mirić
authors: Jasminka
authors: J
authors: Rešić
authors: Mirna
authors: M
authors: Saraga-Babić
mesh_terms: D000368:Aged; D017209:Apoptosis; D001706:Biopsy; D053148:Caspase 3 / Q000378:metabolism; D016923:Cell Death; D002470:Cell Survival; D004817:Epidermis / Q000378:metabolism / Q000473:pathology*; D004847:Epithelial Cells / Q000166:cytology; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D020287:In Situ Nick-End Labeling; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism*; D011537:Pruritus / Q000378:metabolism*; D006435:Renal Dialysis; D012867:Skin / Q000473:pathology*; D051028:bcl-2-Associated X Protein / Q000378:metabolism*
chemical_list: C494826:BAX protein, human; D019253:Proto-Oncogene Proteins c-bcl-2; D051028:bcl-2-Associated X Protein; C505407:CASP3 protein, human; D053148:Caspase 3